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Case study

TriZetto® and SelectHealth

Customer:

selectHealth, Inc., is a nonprofit health insurance company serving members in utah and Idaho. the company offers HMO and PPO plans and covers more than 500,000 lives. In 2009, selectHealth was nominated for a triZetto IHM Power award, in recognition of the company's pursuit of an advanced business model.

The Market

a nonprofit health insurance company covering 500,000 lives.

The Challenge

Implement online billing and enrollment capabilities in order to increase efficiency and improve competitive position as well as constituent satisfaction.

Challenge:

selectHealth wanted to provide automated enrollment and billing functionality to brokers and employers, says shane Rydalch, the company's manager of billing and enrollment. this would improve competitive positioning, boost employer and broker satisfaction, and deliver other advantages as well, he says. "transparency between our employers and brokers was missing," Rydalch says. "We also were very eager to move things online to reduce administrative cost and increase efficiency within the enrollment/billing team."

The Solution

triZetto Constituent Web solutions, integrated with the triZetto Facets core administration system. Within the Constituent Web solutions suite, selectHealth chose the employer and Broker Web solutions, which deliver online enrollment and billing capabilities.

Solution:

after evaluating numerous online solutions in 2005, selectHealth chose triZetto® Constituent Web solutions, which include real-time online enrollment, billing and selfservice capabilities for members, providers and brokers. a key reason for the selection was that triZetto Constituent Web solutions are integrated with the triZetto® FacetstM core system, on which selectHealth processes healthcare claims and conducts other administrative operations. Integration of online tools with the core administration system increases the speed, accuracy and efficiency of transactions, helping lower costs and improve constituent satisfaction. "this is extremely important to us because we believe that we can manage our book of business more efficiently with having the integration," Rydalch says. "We rely on triZetto to make sure that the two systems are talking to each other and that the enhancements to the future upgrades are tested and ready to be put in to production. With the cost of healthcare today, we have to look for opportunities to become more integrated and look for opportunities to automate workflow. this will allow us to keep our cost lower.". triZetto Constituent Web solutions are a comprehensive suite of online tools that automate transaction processing and information exchange between payers and their key constituents. the suite includes numerous applications, including triZetto employer and Broker Web solutions, which automate and streamline enrollment, billing and customer service. employer and Broker Web solutions include the employer and Broker enrollment application, which enables employers and brokers to complete and modify memberenrollment forms online, saving payers time and reducing data-entry errors. employer and Broker Web solutions also provide online billing and self-service capabilities. selectHealth also asked that triZetto services professionals provide implementation support.

The Result

· adoption rate of 25 percent among large employer groups. · Greater efficiency and accuracy, with member enrollment now taking one day, down from three to five days with paper-based enrollment. · strengthened relationships with brokers. · Increased collaboration between brokers and employer groups. · Increased employer and broker satisfaction.

Result:

the implementation of triZetto employer and Broker Web solutions was a success, Rydalch says, noting that "there was good collaboration, from the triZetto project manager all the way down to the design team. they worked very well with our selectHealth staff to ensure the implementation effort was seamless and smooth. the solution we implemented continues to be very solid."

"As a general statement, my thought is that it is about a 33 percent reduction in time for our enrollment processor to validate the electronic transaction versus processing it on paper." -- Shane Rydalch, Manager of Billing and enrollment, SelectHealth

employer and Broker Web solutions have helped selectHealth in three notable areas, he says. "For one, the features and functionality have helped us be more efficient and accurate with member enrollment and billing transactions. secondly, our relationships with our employer groups and brokers have really improved. Lastly, we really feel that the tools have changed our internal dynamic within the company. Our sales force loves that they have more time to work on relationships with our employers and aren't constantly having to double-check enrollment to make sure forms got processed. "as a general statement, my thought is that it is about a 33 percent reduction in time for our enrollment processor to validate the electronic transaction versus processing it on paper," Rydalch says. "Not only are we driving operational efficiencies, but triZetto has allowed us to gain greater competitive positioning in the market place," he says. "When we take the triZetto enrollment tool to employer groups and brokers, they feel our tool is the best they've seen. this is a distinct competitive advantage. employer groups and brokers can see what's going on within the enrollment process." selectHealth employees also like the online tools. "Related to our internal relationships, these tools have really brought our sales force together. It's exciting for our teams to have fewer enrollment issues. Minimizing the forms process is key to better efficiencies and less redundancy on the part of the sales force and enrollment group. sales staff can focus on generating revenue [sales] and less on cross-checking their paper enrollments."

Powering Integrated Healthcare Management®

Integrated Healthcare Management is the systematic application of processes and shared information to optimize the coordination of benefits and care for the healthcare consumer. It is fueled by the convergence of core benefit administration, care management, and constituent engagement. the intersection of these competencies enables payers to leverage data to more systematically stratify, engage and reward constituents and personalize interactions with them in order to motivate healthy behaviors, increase the effectiveness of treatments, reduce the cost of care and drive better results. triZetto has invested in a long-term architectural approach to bring core, care and constituent capabilities together and enable payers to achieve the vision of Integrated Healthcare Management.

For more information on how TriZetto can help you enhance revenue growth, drive administrative efficiency and improve the cost and quality of care, call 1-800-569-1222 or visit www.trizetto.com.

the triZetto Group, Inc. Corporate Office 6061 south Willow drive Greenwood Village, Colorado 80111 1-800-569-1222 www.trizetto.com

Copyright © 2011 The TriZetto Group, Inc. All rights reserved. All rights reserved. TriZetto, the TriZetto Triangle logo and Powering Integrated Healthcare Management are registered trademarks, and Facets is a trademark of The TriZetto Group, Inc. or its subsidiaries. Other company and product names may be trademarks of the respective companies with which they are associated. The mention of such companies and product names is with due recognition and without intent to misappropriate such names or marks.

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