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Case study

The challenge

Physicians Health Plan of Northern Indiana (PHPNI), a commercial not-for-profit carrier, needed to create its first ever care management program in just 12 months to effectively manage the medical requirements of its 50,000 existing members. After reviewing various solutions, the PHPNI team chose Cognizant’s TriZetto CareAdvance Enterprise (CAE) based on our proven performance, strong client base and interoperability with PHPNI’s existing QNXT™ core administration software.

Our approach

PHPNI needed a care management system that would show demonstrable savings and deliver a four-to-one return on project investments. The inherent integration between our CAE and QNXT solutions not only aided in the new system’s rapid implementation but also prepared the carrier to share information with its risk-based contract health systems. This helped PHPNI quickly assume the role of a care management vendor for a third-party administrator. CAE’s standard content package streamlined the carrier’s program development, enabling it to complete the implementation project on time. CAE also enabled PHPNI’s team to establish unique program parameters, through which the plan’s nurses identify and treat members perceived to be at potential medical risk. In addition, its intuitive design, coupled with support from Cognizant and the CAE User Group, helps PHPNI effectively address critical issues and maximize system performance.

Efficient, streamlined care management operations result in lofty business objectives

We helped PHPNI implement a successful care management system that boosts its revenue growth opportunities and helps it achieve high member and provider satisfaction—all within a stipulated timeline—using CAE’s comprehensive functionality and pre-integration with our QNXT core administration software. Our client now offers this service to outside entities, using CAE to support its new, revenue-generating business model.

$1.2 million

in plan savings generated in the first six months of operation

100%+

of all annual fixed program costs recouped within three months

52%

under budget for CAE system implementation