Transcript Document
1
Confidential
|
Copyright © 2014 TriZetto Corporation
QNXT General Session
2
Confidential
|
Copyright © 2014 TriZetto Corporation
Welcome
New Clients since last TriZetto Health Care Conference…
3
Confidential
|
Copyright © 2014 TriZetto Corporation
Agenda
Introductions
QUser Board
Where are we now? – QNXT
QNXT™ T3 Update
Workflow
What else is new?
Closing
4
Confidential
|
Copyright © 2014 TriZetto Corporation
Quser Presentation
5
Confidential
|
Copyright © 2014 TriZetto Corporation
QUsers
Welcome
QUsers Group
Formally organized in 2006
Established for the purpose of exchanging ideas, best practices,
and solutions to provide quality, cost-effective health plan
administration.
Provide the forum to share information to maximize the
effectiveness and use of the QNXT™ suite of products and
services.
Promote QNXT best use and future direction in a forum of
collaboration and partnership between TriZetto and its
customers
6
Confidential
|
Copyright © 2014 TriZetto Corporation
2014 / 2015 Goals and Objectives
7
Confidential
Membership Drive
Reduced Membership Dues
Increased Networking
Active Sub-Committees
ICD10 Implementation
CORE Certifications
ACA Mandates
QNXT™ Enhancement Voting
Software Quality and Support
Product Demonstrations
|
Copyright © 2014 TriZetto Corporation
2014 / 2015 Board of Directors
President
Vice President/Events
Treasurer
Membership
QUG CX Portal /
Communication
Susan Butts, Cox HealthPlans
Gail Doran, PHPNI
Eric Smith, Capital Health Plan
Sharon Perkins, El Paso First
Sharon Perkins, El Paso First
Member-at-Large
Linda Katagiri, HMSA
TriZetto Reps
Dale Hoerle/Jon Price, TriZetto
Two New Board Members
8
Confidential
|
Copyright © 2014 TriZetto Corporation
Welcome New Board Member
Frank Barresi
CIO Information Technology
Fallon Health
As CIO Frank is responsible for the overall delivery and support of IT services for Fallon. Technology areas include:
Enterprise Architecture, Enterprise Infrastructure, Application Development Support and Quality Assurance,
Business Systems Analysis, Project Management Office, and eBusiness & Digital Services.
Frank has over 25 years IT experience and has served in a variety of IT leadership roles across Healthcare, Financial
Services and Consulting. Frank served as Vice President of IT at AmeriHealth Caritas in Philadelphia, PA and was
responsible for Infrastructure and IT Operations and building out a highly scalable platform and infrastructure to
support AmeriHealth’s growth in the Medicaid market across the U.S.
Frank served as CIO for CIGNA Pharmacy
management/TelDrug and CIGNA Behavioral Health at CIGNA, providing common leadership to develop a data
integration strategy within their medical business. Frank held senior leadership roles delivering CIGNA’s initial key
consumer-directed product, Choice Fund, integrating early innovations in their HSA, HRA and FSA as well as leading
the delivery of CIGNA’s first Provider portal within CIGNA’s eCommerce technology practice. Other key technology
domains and functions that Frank has experience with include: Information Delivery, Data Integration, Business
Analytics, Enterprise Architecture & Strategic Systems Planning in addition to Systems Design, Development &
Testing while at Andersen Consulting/Arthur Andersen, (now Accenture).
Frank graduated with a Bachelor of Arts in Physics from College of the Holy Cross in Worcester, Massachusetts. He
also earned an M.B.A. from the University of Connecticut in Storrs, Connecticut with a concentration in Management
& Organization.
9
Confidential
|
Copyright © 2014 TriZetto Corporation
Welcome New Board Members
Louise McCagg
VP Information Technology
Cigna – Health Spring
Louise is a seasoned IT professional who has worked with QNXT since 2006, selecting and implementing the
application for Bravo Health. Her current responsibility includes all aspects of management of the application and
associated development efforts for Cigna-HealthSpring. Louise has developed expertise in Medicare Advantage,
Medicaid and Medicare-Medicaid Alignment Initiative plans, especially relating to administering these plans on
QNXT.
She has previously held positions on managed care, provider relations, contracting and operations teams with
Humana and United HealthCare.
Louise comments…
“I am interested in serving as a board member to deepen my knowledge of QNXT, make contacts with like folks at
other organizations, to have an active role in potential changes to QNXT and to share what I have learned about
QNXT, especially from the Medicare Advantage and Medicaid perspective.>
10
Confidential
|
Copyright © 2014 TriZetto Corporation
Seven Sub-Committees
Best Practices/Regulatory—Susan Butts,
[email protected]
Government Programs and Collaborators—Corine
Peterson, [email protected]
ITS (Blues)—Open
New Implementation—Lori Sowle, [email protected]
Performance—Ken Leisey,
[email protected]
Quality—John Harbourne, [email protected]
CWS—Jason Strong, [email protected]
11
Confidential
|
Copyright © 2014 TriZetto Corporation
Events
Welcome to the Spring Conference
Logistics
QUsers Networking Lunch
QUsers Home Room
Introduction to Laura Pasteur
[email protected]
Fall Conference Information
YOUR conference
Topics
Case Studies
Planning begins today
12
Confidential
|
Copyright © 2014 TriZetto Corporation
QNXT™ Enhancement Requests
Important Dates:
5/27/14 – 7/22/14—Enhancement submissions via Customer
Exchange
9/15/14 – 9/17/14—QUsers Group will review the enhancements
at the Fall Users Conference
9/29/14 – 10/24/14—Open voting for enhancements via
Customer Exchange
November TriZetto will review enhancements and
announce which will require business requirements
13
Confidential
|
Copyright © 2014 TriZetto Corporation
QNXT™ Enhancement Requests
All enhancements suggestions are welcome!
Suggestions need only be a short summary outlining
the issue to be resolved or a new feature
Instructions for enhancement submission and voting
can be found on Customer Exchange
Customer Exchange ➔ User Groups ➔ QUsers Groups ➔ Enhancement Survey
14
Confidential
|
Copyright © 2014 TriZetto Corporation
QUser Membership: Who Are We?
36 Health Plans
Covered lives range from 10,000 to over 1 million
Product lines: Commercial, Medicare, Medicaid, TPA,
Self-Funded, ACO and Dental
15
Confidential
|
Copyright © 2014 TriZetto Corporation
QUsers: Customer Exchange
Subcommittee
information
Meetings
Announcements
Questions and
answers
Documentation
16
Confidential
|
Copyright © 2014 TriZetto Corporation
QUser Membership: How Do I Join?
Sharon Perkins
[email protected]
(915) 298-7198 x1103
17
Confidential
|
Copyright © 2014 TriZetto Corporation
Where are we now –
QNXT™?
18
Confidential
|
Copyright © 2014 TriZetto Corporation
TriZetto Organization: QNXT Bend
Jude Dieterman
President and
COO
Dale Hoerle
VP Software
Engineering and
CTO
Alan Stein
SVP Product
Management
Scott Hampel
VP Product
Management
Kathy Wiley
VP Product
Management
Todd Tipton
VP Portfolio
Management
Gary Cahill
AVP Sales
Overlay
Jon Price
AVP QNXT
Product Mgmt,
Sales and Mktg.
Marty Newton
VP Portfolio
Management
Derrick Drewry
Director Software
Engineering
Tom Kerns
SVP Consulting
Services
Eric Sommers
VP Consulting
Michael Pierce
VP Consulting
Karen Callahan
AVP Consulting
Marvin Matthews
AVP Consulting
Rob Scavo
SVP Markets
Rob Renzi
SVP Sales
Sal Gentile
Market President
Alignment between TriZetto’s solutions and client
needs / requests
Integration of TriZetto Provider Solution into T3
Markets geographic focused model and the addition
of the Dedicated Account Management team
19
Confidential
|
Copyright © 2014 TriZetto Corporation
Bottom Line Difference
Dale Hoerle
VP Software
Engineering and
CTO
Alan Stein
SVP Product
Management
Scott Hampel
VP Product
Management
Kathy Wiley
VP Product
Management
Todd Tipton
VP Portfolio
Management
Gary Cahill
AVP Sales
Overlay
Jon Price
AVP QNXT
Product Mgmt,
Sales and Mktg.
Marty Newton
VP Portfolio
Management
More efficient
organization
Derrick Drewry
Director Software
Engineering
Tom Kerns
SVP Consulting
Services
Eric Sommers
VP Consulting
Michael Pierce
VP Consulting
Karen Callahan
AVP Consulting
Marvin Matthews
AVP Consulting
New solution
opportunities
Rob Scavo
SVP Markets
Rob Renzi
SVP Sales
Sal Gentile
Market President
Working with
people you
know
Alignment between TriZetto’s solutions and client
needs / requests
Integration of TriZetto Provider Solution into T3
Markets geographic focused model and the addition
of the Dedicated Account Management team
20
Confidential
|
Copyright © 2014 TriZetto Corporation
Release Cadence
History – Yearly
Big jumps with lots of enhancements to take on
Then 8 weeks, like clockwork
Got us thinking and moving agilely
Allowed us to bring new features, more quickly
Was not always easy for you to keep up
Now 13 weeks
Blending the two
Still allows to think and act agilely
Allows us bring new features to you quickly
21
Confidential
|
Copyright © 2014 TriZetto Corporation
What We’ve Delivered Since Last Year
Exchange Enhancements
Tax Credits
Subsidy
Premium Billing Support
834 Readiness
270 / 271 Member Grace Period
A/R Past Due
Cost Share Adjudication
APTC Grace Period
834 Non-Exchange
Compliance
Enhancement(s)
Claim Form Enhancements
ITS Real Time Home
SQL 2012 Support
EFT Support
CAE Integration
5010 Connect Agent Update
Medicare Enrollment
Sequestration
Multiple Grouper / Single
Program
Input / Output XML
viewer
ITS 14.0
Melissa Geo-Coding
Interface with TTPS
270/271 Real Time
276/277 Real Time
270/271 Grace Period
iCES – Institutional
Claims Support
iCES – 5.0 Upgrade
SQL Injection Protection
Config Option Module
CARC/RARC
Prevention of
Authorization Bypass
834 Dependent Term
Rules, Retro Term
A/R Account
Consolidation
TMS ICD-10 Support
Select Contract by Pay-To
Affiliation, not PCP
Micro-Dyn ICD-10 ASC
PRICERActive
SHOP Broker
Claims Workflow Content
Micro-Dyn Grouper
BizTalk 2013
Fee Table Search
Government Programs
Regulatory
Administrative Efficiency
Integration
ITS
Technology
LEGEND
22
Confidential
|
Copyright © 2014 TriZetto Corporation
T3 Update
23
Confidential
|
Copyright © 2014 TriZetto Corporation
QNXT™ Quality Review
Defect Backlog Reduction
Client Reported May 2013: 237
Client Reported May 2014: 87
No Client Severity 1 since April 2012
Client Reported Severity 2’s
2012: 23.5 per month
2013: 13.54 per month
2014 to-date: 7.25 per month
24
Confidential
|
Copyright © 2014 TriZetto Corporation
2012.10.06
2012.10.20
2012.11.03
2012.11.17
2012.12.01
2012.12.15
2012.12.29
2013.01.12
2013.01.26
2013.02.09
2013.02.23
2013.03.09
2013.03.23
2013.04.06
2013.04.20
2013.05.04
2013.05.18
2013.06.01
2013.06.15
2013.06.29
2013.07.13
2013.07.27
2013.08.10
2013.08.24
2013.09.07
2013.09.21
2013.10.05
2013.10.19
2013.11.02
2013.11.16
2013.11.30
2013.12.14
2013.12.28
2014.01.11
2014.01.25
2014.02.08
2014.02.22
2014.03.08
2014.03.22
2014.04.05
2014.04.19
QNXT™ Quality Review
QNXT Weekly Open Defect Trending
800
700
600
500
400
Defect backlog
300
25
Internal Found
Client Reported
200
100
0
Confidential
|
Copyright © 2014 TriZetto Corporation
QNXT™ Quality Review
QNXT Defects Opened By YYMM and Origin
120
100
80
60
Internally Found
Client Reported
40
20
0
26
Confidential
|
Copyright © 2014 TriZetto Corporation
QNXT™ Quality Review
Client Reported QNXT 2009-2013 Defects by Component
400
350 338
2009
Defects
2010
Defects
2011
Defects
2012
Defects
2013
Defects
300
C
o
u
n
t
250
200
150
100
50
198
183
173
130 131
84
89
73
59
43
114
104
85
54
103
86 79
49
44
32 25
77
75 82
62
60
54 48
49
17
67
54
3127
25
25 232224
12
46
40
33
29
28
23 24 1616
139 17810
12 2014411 22617118 211114149 71715
10
0
0
Components
27
Confidential
|
Copyright © 2014 TriZetto Corporation
QNXT™ Support: Incident Event Survey
95% of respondents were satisfied with accuracy of
resolution
Took too long to assign your incident to a support
expert
What are we doing about it?
In October 2013, we had 180 unassigned incidents
In April 2014, we have 0
How can you help?
Engage us early during your upgrade process
28
Confidential
|
Copyright © 2014 TriZetto Corporation
QNXT™ Incident Backlog: Then and Now
October 2013
410 incidents in the backlog with 180 unassigned
April 2014
320 incidents in the backlog with 0 unassigned
We did it while training 5 new associates!
29
Confidential
|
Copyright © 2014 TriZetto Corporation
QNXT™ Resolving Incidents Within SLG
30
Confidential
October 2013 met SLG 58% of the time
March 2014 met SLG 64% of the time
April 2014 met SLG ??% of the time
Goal is to be at 80% by July
|
Copyright © 2014 TriZetto Corporation
Architectural Advancement
Integrations
QNXT UI
Custom Code
RESTful Web Services
QNXT
Business
Domain
Unit
Tests
Data
Storage
31
Confidential
|
Copyright © 2014 TriZetto Corporation
Architectural Advancement
Domain Driven Design
All business related logic and decisions centralized into Domain
Business rules, processes and procedures
Business and technology experts collaborate throughout the
Domain building process
Technological decisions can reside outside of core Domain logic
Changing a UI to a different platform
Changing the data storage to another vendor
Agnostic to development processes
32
Confidential
|
Copyright © 2014 TriZetto Corporation
Architectural Advancement
RESTful Web Services
33
Confidential
|
Extensibility layer that exposes Domain logic
Follows HTTP web standards to ease integrations
New QNXT UI, other software integrations and custom code
Lightweight transport options for better performance and
scalability
Copyright © 2014 TriZetto Corporation
Architectural Advancement UI Overview
Browser Z
Browser X
Browser Y
Patient:
Provider:
Save
Patient:
Provider:
Patient:
Provider:
From Date:
Save To Date:
Save
Content Server
Web API Server
Domain Logic Server
34
Confidential
|
Copyright © 2014 TriZetto Corporation
Web API Server
Architectural Advancement UI
Angular JS
Future proof JavaScript Library provided by Google
Set to support current and future web technologies
Enforces strict decoupling of business logic from UI logic
Minimizes future maintenance complexities
Supports Unit Testing
Build robust, flexible code base that can withstand change
35
Confidential
|
Copyright © 2014 TriZetto Corporation
Architectural Advancement UI
Bootstrap
Create flexible, cross browser user experience
Support for Responsive Design
Built-in support for mobile platforms including tablets and
phones
Reacts to changes to browser window size on desktop
platforms
36
Confidential
|
Copyright © 2014 TriZetto Corporation
QNXT Workflow™
37
Confidential
|
Copyright © 2014 TriZetto Corporation
TriZetto’s Workflow Product Experience
TriZetto created a proprietary workflow engine that is
in use today
Facets Workflow™ solution in use today by more
than 50% of Facets clients
TriZetto leveraging what has been learned through
Facets Workflow
TriZetto has built a new Workflow rules engine
modeled after our existing solution
New technology
New services
New web UI
38
Confidential
|
Copyright © 2014 TriZetto Corporation
What is QNXT Workflow™ for Claims?
Real Time
Automated
Integrated
Configurable
Work Prioritization
User Queues
Manager Dashboard
39
Confidential
|
Copyright © 2014 TriZetto Corporation
How it works…
Claim workflow is called “in-line” during QNXT adjudication no separate batch processes required
Configurable rules and data elements used to identify claims in
need of workflow
The process will act upon the claim in real time
Identify claims by QNXT edits
Identify claims using non-edit related data
Prioritize claims using multiple criteria
Manually route claims
Route claims to specific user or user group queues
Role based user queue assignment
Flexible configuration provides options for work groups or individual
queues
40
Confidential
|
Copyright © 2014 TriZetto Corporation
How it works…
Introducing a new QNXT Claim UI
Existing QNXT Claim UI still available
QNXT Workflow for Claims uses a new claim UI
New QNXT Claims UI sets the model for future QNXT UI
updates and improvements
QNXT Claims Examiners/Users
New “Get Next” claim feature
Next claim to be worked is identified based on Workflow rules
Edit
Priority
User Role
Other
Existing QNXT “Claims Workflow” module will
remain but will be renamed.
41
Confidential
|
Copyright © 2014 TriZetto Corporation
Go from this…
42
Confidential
|
Copyright © 2014 TriZetto Corporation
To this…
43
Confidential
|
Copyright © 2014 TriZetto Corporation
QNXT Workflow™
Product Snapshot
44
Confidential
|
Copyright © 2014 TriZetto Corporation
Workflow Role Definition
45
Confidential
|
Copyright © 2014 TriZetto Corporation
Workflow Queue Rules
46
Confidential
|
Copyright © 2014 TriZetto Corporation
QNXT™ Queue Roles
47
Confidential
|
Copyright © 2014 TriZetto Corporation
Workflow Routing Rules
48
Confidential
|
Copyright © 2014 TriZetto Corporation
Workflow Qualifier Groups
49
Confidential
|
Copyright © 2014 TriZetto Corporation
Workflow Administration
50
Confidential
|
Copyright © 2014 TriZetto Corporation
Workflow Manager Dashboard
51
Confidential
|
Copyright © 2014 TriZetto Corporation
QNXT Workflow™ History
52
Confidential
|
Copyright © 2014 TriZetto Corporation
QNXT™ Claim Search
53
Confidential
|
Copyright © 2014 TriZetto Corporation
QNXT™ Claim
54
Confidential
|
Copyright © 2014 TriZetto Corporation
QNXT Workflow™ Release Schedule
Initial delivery August 2014
General
availability November 2014
55
Confidential
|
Copyright © 2014 TriZetto Corporation
QNXT Workflow™
Proof of Concept Demo
Monday 1:15
TriZetto Innovations Gallery
56
Confidential
|
Copyright © 2014 TriZetto Corporation
What Else is New?
57
Confidential
|
Copyright © 2014 TriZetto Corporation
Market Focused
QNXT Workgroups
QNXT Development (T3) will facilitate Product Workgroups
Content will focus on;
Current features and functionality
Future enhancements
Forum for demos, requirements gathering, feedback, lessons learned
Open to all QNXT clients and TriZetto Colleagues
Active Product Workgroups include
Exchanges
Candidates for future Product Workgroups
Connect
Technology
Performance
Medi-Cal
TMS/EAM
Workflow
Usability
QXI
Pricing
Duals
Volunteers for QNXT 5.1 R7
58
Confidential
|
Copyright © 2014 TriZetto Corporation
QNXT™ Roadmap: 12 Month View
59
Confidential
|
Copyright © 2014 TriZetto Corporation
QNXT™ Roadmap: 12 Month View
Regulatory
60
Confidential
|
Copyright © 2014 TriZetto Corporation
Government
Programs
Integrations
Administrative
Efficiency
Technology
Regulatory
ADA Form
ACA / Operating Rule
Claims Attachments
834
820
278
837
QNXT 5.2 Volunteer Candidate
61
Confidential
|
Copyright © 2014 TriZetto Corporation
Government Programs
Exchange Support
SHOP 834
Broker support
Group Load
Dual Eligibles Support
Division Of Financial Responsibility
(DOFR)
HIX / HIPAA 820 Inbound
Physician 9 Digit Zip Code
Medicare Procedure Payment Reduction
(MPPR)
Therapy
Imaging
QNXT 5.2 Volunteer Candidate
62
Confidential
|
Copyright © 2014 TriZetto Corporation
Integrations
TriZetto Workflow
NetworX®
Pricer
Payment Bundling
TriZetto Communication System
Micro-Dyn ESRD
McKesson ClaimsXten
QNXT 5.2 Volunteer Candidate
63
Confidential
|
Copyright © 2014 TriZetto Corporation
Administrative Efficiency
QNXT™ Customer Voted Enhancements
Multiple Co-Pay
Auth Matching – Denied Auths
Configurable Provider Types – Auth Matching
Advanced Capitation
Accumulator Access
Archiving Support – Static Accumulation
TriZetto Workflow Connectors
Member / Enrollment
EDI / Batch Processing
Provider
Authorization
QNXT 5.2 Volunteer Candidate
64
Confidential
|
Copyright © 2014 TriZetto Corporation
Technology
.NET 4.5
MicroSoft Internet Explorer 10 / 11
support
Cumulative Installs (MSI/MSP)
SQL Injection Protection
Authentication Bypass with Forceful
Browsing
Privilege Escalation / Authorization
Bypass
Windows 2012 Support
QNXT 5.2 Volunteer Candidate
65
Confidential
|
Copyright © 2014 TriZetto Corporation
QNXT™ Roadmap: 24 Month View
66
Confidential
|
Copyright © 2014 TriZetto Corporation
Closing
67
Confidential
|
Copyright © 2014 TriZetto Corporation
Thanks and don’t forget to see………
SOLUTION
CENTER AND
EXHIBITS
TriZetto Products
Exhibits
Partner Sessions
BREAKOUT
SESSIONS
TriZetto
Integrations
CLIENT
SUCCESS
STORIES
ICD 10 – The last
mile
QNXT Reform
USER GROUP
MEETINGS
Adoption Leaders
Program
68
Confidential
|
Copyright © 2014 TriZetto Corporation
QUser Group
Meeting
Thank You!
69
Confidential
|
Copyright © 2014 TriZetto Corporation