Transcript TriZetto 2008 Corporate Template

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Copyright © 2014 TriZetto Corporation
Implementation Means
Collaboration
Chris Rugg – Blue Cross and Blue Shield of MN
Manager – Network Pricing Methodology & Provider Pricing
Jim Hall –TriZetto
Senior Product Manager
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Agenda
 About Blue Cross and Blue Shield of Minnesota
 NetworX™ Implementation Overview
 Implementation Story
 What we did
 Enhancements & Innovations
 Lessons Learned
 NetworX in our Business
 How we use NetworX
 How we manage NetworX
 Collaboration with TriZetto
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About Blue Cross Blue Shield of Minnesota
Minnesota’s market leader
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Nearly 2.7 million members
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One in three Minnesotans is covered
by Blue Cross
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Largest health plan in the state
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More than 98 percent of all hospitals
and physicians
National scope
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Access to the largest provider network
in the U.S., including more than 90
percent of hospitals and 80 percent of
physicians
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Covering over 99 million people
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379 of the top 500 U.S. companies
count on the Blues*
*Each local Blue Cross and Blue Shield plan is an independent licensee of the Blue Cross and Blue Shield Association
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Implementation
Story
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Copyright © 2014 TriZetto Corporation
NetworX™ Implementation Overview
 Blue Cross and Blue Shield of MN (Blue Cross) purchased
stand-alone NetworX Pricer and Modeler in 2009
 Installation and implementation work completed in 2010
 SIT and BAT testing completed during the first-half of 2011
 Pricer go-live in July 2011 with all commercial providers
moved to Pricer by August 2011
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Implementation Story
Dedicated team of business and IT staff
 Each business analyst was a subject matter expect (SME)
 TriZetto consultant was on-site and part of the business team
 Multiple project managers based on key deliverables
 Established a dedicated “war room”
Created full inventory of contracts to be transitioned
 Created reporting to inventory all provider contracts
 Analysts researched and categorized each contract to identify
requirements
 “Gaps” identified early and enhancements requested
 Identified all components needed for go-live
(i.e. Fee Schedules, Calc beans, Code Groups, etc.)
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Implementation Story
IT staff worked with TriZetto on install and configuration
 Work included establishing application environments, claim system
modifications, etc.
 Dedicated team established to populate Modeler database
 Loaded three-years worth of claims
 Data mapping process was lengthy
Built and tested each Modeler rate sheet template
 Started by building required code groups, schedules, and rate sheet
templates
 Extensive testing done for each template to ensure all components
worked appropriately
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Implementation Story
Built all Modeler Rate Sheets
 Initially built around 1,000 rate sheets that mirrored our current
commercial pricing
 Each rate sheet was audited to ensure correct rates
All commercial contracts transitioned at Go-Live
 Training for all staff completed “just in time” to help with retention
 Automated program scripts updated provider demographic system
 Transitioned all providers at once
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Implementation Story – Enhancements & Innovations
Created Global Rate Sheets
 Allows for universal changes to default pricing
3M APR-DRGs and EAPG
 Commercially-based groupers for hospital pricing
 Currently being rolled out to all of our hospitals
Streamlined process for updating contract rates
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Implementation Story – Lessons Learned
Optum Medicare Payment Groupers
 Commercial claims can cause errors with groupers due to having
inconsistent claims information
Claim System Integration w/ Stand-Alone NetworX Pricer
 Each Pricer calculation needs to be tested to ensure compatibility with
claims system
Pricer / Modeler reporting
 Reporting from these applications is complicated and requires skilled
programmers
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NetworX ™
in our
Business
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How We Use NetworX™
Modeler is our “source of record” for all NetworX Rate Sheets
 Tight controls on Rate Sheet creation
 Follow approved templates
 Created by Finance Analysts in Modeler
 Tested and approved by Pricer Administration team
Approved Rate Sheets transferred to NetworX Pricer for adjudication
process
Approximately 3,600 rate sheets have been built to date
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How We Manage NetworX™
Business Pricer / Modeler Administrative Support
 Ongoing maintenance of payment methodologies, default pricing,
tables updates
 Development of business processes
 Business testing of all application and grouper upgrades
 Audits of TriZetto rate sheets that will be used for pricing claims
 Day-to-day research and issue resolution
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How We Manage NetworX™
Business Financial Analysts
 Build rate sheets for negotiated contracts
 Financial modeling
Network Implementation
 Setup our provider demographic system to use updated Pricer rate sheets
IT Pricer / Modeler Support
 Dedicated internal and external resources
 Work with various areas of Blue Cross to coordinate updates and testing
 Database management
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Collaboration
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Collaboration with TriZetto
Regular meetings with TriZetto Team
 Product Management / Development / Support
 Discuss open issues
 Discuss new opportunities / enhancements
Regular communication with our Account Executives
 Keep informed of overall performance and satisfaction
 Collaborate on initiatives and strategy
Product Enhancement Overviews
 Learn more about enhancements / fixes for upcoming TriZetto releases
 Client Engagement Reviews
 Product Roadmap
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Workshop Survey
We would like to extend you an opportunity
to provide candid feedback.
During the workshop you should have received an e-mail
notification for you to take an on-line survey.
If you could take a few minutes to complete at this time ,
we would greatly value your feedback. For your convenience,
the survey will be available throughout the remainder of the conference
should you not be able to complete immediately.
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Thank You!
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