4-page Case Study - Posted 4/17/2006
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Leading Health Insurer Realizes Benefits of Automation and Collaborative Care
BlueCross BlueShield of Tennessee chose CareAdvance Enterprise from TriZetto to provide medical management for its members on a single platform. Using rule-based automation, the Microsoft® technology–based solution provides catastrophic care coordination, chronic disease management, and wellness and family care with better quality and reduced cost. Further, the application’s multichannel, bi-directional communication capabilities are an integral part of the organization’s ongoing consumer-focused initiatives. The result is improved customer care and the flexibility to deploy similar solutions across the enterprise.
Situation
BlueCross BlueShield (BCBS) of Tennessee is the state’s leader in healthcare financing, serving more than 2.8 million customers. This not-for-profit organization serves plans in the commercial market as well as products for Medicare and Medicaid enrollees.
Like other health insurance organizations, BCBS of Tennessee continually looks for ways to combat skyrocketing healthcare costs while improving services and enhancing member satisfaction. In addition, BCBS of Tennessee recognizes the impact of consumerism and is responding through healthcare record portability and collaborative care initiatives.
In order to achieve this mission, the company sought to bring a disease management capability in-house. This required a dramatic expansion of both the functionality and automation of its care management and case management capabilities. “We wanted a system that obviously had the right functionality, but we also wanted to pick a system that was running on a platform such that it could be very easily integrated into the solutions that we had in place,” says Chris Levan, CIO of BCBS of Tennessee.
Faced with an IT environment that included two major processing systems for different populations, disparate data file formats, complex workflows, and complicated care coordination, BCBS of Tennessee knew it needed an agile, scalable, and interoperable care management application that could make use of multiple data sources and integrate easily with the existing infrastructure.
Solution
As the requirements evolved, BCBS of Tennessee evaluated a number of systems but was not able to find anything that matched its objectives. According to Levan, the available offerings were often costly and did not offer any additional functionality beyond the company’s current capabilities. When the company's head of care management discovered the CareAdvance Enterprise solution from TriZetto, built on the Microsoft® SQL Server™ database and the Microsoft Windows Server™ 2003 operating system (both part of Microsoft Windows Server System™ integrated server software), it was the first indication that a compelling offering might be available. “The fact that it is so functionally rich and on a technical platform that we thought would work well in our environment, that’s what led us to taking a really hard look,” Levan says.
 | The fact that it is so functionally rich and on a technical platform that we thought would work well in our environment, that’s what led us to taking a really hard look. |  | | Chris Levan,
CIO, BlueCross BlueShield of Tennessee | |
|
In the fall of 2004, BCBS of Tennessee chose to submit a bid on a disease management program for a chronically ill population. Part of that RFP required that responders be able to demonstrate a working pilot. BCBS of Tennessee chose to build a diabetes pilot for disease management. Partnering closely with TriZetto and strategic business partner at the time, CareKey, Inc., BCBS of Tennessee was able to build a working pilot for disease management in about six weeks, “an almost unheard-of time frame,” Levan notes.
The success of the pilot led BCBS of Tennessee to partner with TriZetto to extend beyond case and disease management programs to a full care management solution that includes a personal health record that integrates with BCBS of Tennessee’s existing Facets and Amisys processing systems. The result would be a unified medical management program across the entire membership.
The CareAdvance Enterprise application is a secure program based on Microsoft .NET connection software that gives members, health plan staff, and community care providers improvements in a number of areas. From securely exchanging clinical information and collaborating on care, to coordinating workflows, integrating multiple data sources and formats, offering remote access to nursing staff, performing analytical reporting, and creating multiple communication channels for members, the impact has been significant.
TriZetto selected Microsoft technology because of the scalability and flexibility of the products. For Deborah Bradley, RN PAHM, and Vice President for Advanced Care Management at TriZetto, “The open architecture allows us to import additional data sources and to automate activities in the application on a high and large scale.” Adds Todd Fiddler, Manager, Payments and Provider Systems at TriZetto, “The functionality is very rich. It has all kinds of capabilities that we didn’t have in our existing systems, and it’s worked very well. The users are very pleased with what they see.”
Benefits
Since the initial deployment of CareAdvance, BCBS of Tennessee members have had more complete access to plan information and support, and care providers have been better able to coordinate their efforts using the information members can now provide. BCBS of Tennessee has 730,000 Medicaid members who are eligible to use the disease care management portion of the system, and the company is in the midst of expanding the service to its 1.8 million commercial members in the spring of 2006. “We’re able to improve the health of people that are very sick, but in a cost-efficient and quality way,” says Levan. By bringing one very limited disease management program in-house, BCBS of Tennessee expects to save U.S.$4.6 million annually.
BCBS of Tennessee also believes the solution will contribute toward helping the company remain competitive economically. Levan is anticipating compelling economies of scale as the company moves forward with applying the solution to its remaining lines of business. “If we do that, we’ll be able to deliver this solution in a very economical way and with a really low per-member/per-month cost. So we think we’ll have a very competitive offering there from a price standpoint,” Levan says.
Scalability of the solution is also a key benefit of the Microsoft technology–based solution. Levan says, “The platform is solid technically, is scalable, and provides interoperability with our other systems. The Microsoft platform is a definite player in the health plan industry.”
Bob Vaden, a Network Engineer II with BCBS of Tennessee adds, “We like the idea that the presentation layer, business layer, and back-end SQL Server can grow as needed. Scalability is an important consideration for any company in the healthcare industry. While the system is well-utilized with customers, on the IT side there is still quite a bit of room to grow.”
The system also provides reporting flexibility, which the company has used to open up inquiry access and allow “super users” to run some of their own customized reports. As for customers, “the platform allows us to extend a defined set of reporting out to employer groups while also engaging the physician,” Vaden notes.
The combination of the CareAdvance solution’s functionality and the technical capabilities of SQL Server and the Windows Server 2003 platform has allowed BCBS of Tennessee to enter new disease management markets. “We’re very well positioned with a number of items coming down the consumerism pike, like personal health records and member portals,” says Levan.
Perhaps most important is that the success of the solution to date has given BCBS of Tennessee the confidence to put all its commercial businesses on the system, where the full benefits can be felt across the entire company.
As Levan points out, healthcare has always required a great deal of coordination and cooperation from hospitals, physicians, healthcare payers, and members’ families. While there has been, and probably will be, a tremendous amount of change and development in both technology and healthcare, the need for collaboration-enabling solutions has never been greater, and BCBS of Tennessee now feels ready to meet those challenges.
“Having something where all the players can come together in a collaborative way to deliver the best care, at the best cost, with the best quality for that member is something that’s demanded by the marketplace today,” Levan says. “We’re very well positioned to do that.”
Microsoft Windows Server System
Microsoft Windows Server System is a line of integrated and manageable server software designed to reduce the complexity and cost of IT. Windows Server System enables you to spend less time and budget on managing your systems so that you can focus your resources on other priorities for you and your business.
For more information about Windows Server System, go to:
www.microsoft.com/windowsserversystem
For More Information
For more information about Microsoft products and services, call the Microsoft Sales Information Center at (800) 426-9400. In Canada, call the Microsoft Canada Information Centre at (877) 568-2495. Customers who are deaf or hard-of-hearing can reach Microsoft text telephone (TTY/TDD) services at (800) 892-5234 in the United States or (905) 568-9641 in Canada. Outside the 50 United States and Canada, please contact your local Microsoft subsidiary. To access information using the World Wide Web, go to:
www.microsoft.com
For more information about TriZetto products and services, visit the Web site at:
www.trizetto.com
For more information about BlueCross BlueShield of Tennessee products and services, visit the Web site at:
www.bcbst.com
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