New reimbursement structures, care models and technology standards are motivating health plans to evolve their care management programs. TriZetto® CareAdvance solutions leverage new technologies to create a complete and accurate picture of member health driving comprehensive and timely care management, with less manual effort and cost. These solutions are fully integrated with the Facets® and QNXT™ claims systems, and include substantial libraries of pre-built workflow along with industry-standard clinical criteria.

The Clinical CareAdvance® care management solution includes these capabilities:

• Fully automated and integrated Care Management, Disease Management and Utilization Management functions
• Productized integrations for utilization management decision support with MCG and Change Healthcare
• Flexible analytics platform, with rules engine and open IT architecture, to integrate results from health plan analytic systems for over 300 data points (i.e., Episode Treatment Group, Predictive Modeling and gaps in care)
• Lab and Pharmacy Benefit Management data upload capability
• Pre-integration to QNXT/Facets
• Cloud-enabled and web-based architecture
• Integration to CareAdvance Provider®, which extends UM functions to provider desktops
• Integration to TriZetto® Value-Based Benefits, which adds member incentive program functionality