Optimize experiences while lowering costs

• BPaaS improves healthcare CX
• Health plan cuts key costs by more than 50%
• Powering business expansion with TriZetto QNXT
• No-disruption migration with robotic process automation

The challenge

Parkland Community Health Plan needed to meet the growing needs of its medically underserved populations. It sought to digitize its IT platform to better manage health data, member transactions and its provider network. The client wanted to transition from outsourced administration to remedy declining membership and gain better reporting.

Our approach

We introduced the TriZetto® QNXT™ core administration platform in a business process-as-a-service (BPaaS) model to include enrollment, claims, customer service and regulatory reporting modules, giving the client the flexibility and scalability needed to carry out its long-term growth plans.

Business outcomes

• Enhanced productivity
• Decreased core system costs
• Compliant transition in a virtual environment

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The challenge

When our client won a bid to significantly expand its Medicaid membership, the plan was required to begin supporting more than 200,000 additional members. Claims volumes, member support needs and associated business processes needed to scale rapidly while continuing to meet stringent quality standards.

Our approach

The plan leveraged the native scalability of its core system, TriZetto® Facets®, to decrease customization, allowing it to put extra focus on improving annual upgrade patterns, renovating old code, improving batch job execution, and improving monitoring and alerting.

Business outcomes

• Reduced costs per member by nearly 54%
• Reduced costs per claim by more than 52%
• Reduced batch errors

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The challenge

MedPartners was using an on-premises core system to provide administrative and claims processing services and outsourced its claims adjudication services to the core system’s vendor. As business grew, the core system couldn’t support the client’s business expansion plans.

Our approach

We implemented the TriZetto QNXT platform which has the automation and integration capabilities needed to automate critical manual processes and integrate key third-party systems and applications.

Business outcomes

• Saved $821,240 in annual labor costs
• Increased auto-adjudication to 75%
• Achieved 50% automation of referral program
• Increased operational efficiencies by 50%
• Redeployed 25% of staff to other key initiatives

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The challenge

CareOregon needed to implement the TriZetto QNXT platform and migrate its behavioral health line of business to QNXT without disruption. Most of the plan’s behavioral health contracts were case rate value-based contracts that would be complex to translate to core functionality, and the client had to accurately import thousands of new providers and authorizations from its legacy system.

Our approach

We developed robotic processes to streamline the migration and ongoing processes. We quickly developed unique scripts, identified and prioritized the most critical processes, and aligned member and provider data—all leading to the development of nine robots for specific tasks and processes.

Business outcomes

• 162% return on each dollar invested
• 10,000+ hours saved monthly

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