A few months ago I wrote about CareMore in southern California investing in business intelligence claim and cost software services and now we have another in northern California. Companies as such are making a ton of money with providing software that evaluates and presents business models to save cost and hopefully improve health care outcomes. As you read through here, an audit trail of all activity for each patient is created. 
CareMore Health Plan Invests in Business Intelligence for Acute and Chronic Illness Management
Notice the emphasis below: Claims Pricing. Certainly with the complexity of healthcare and who gets paid for what today, companies who provide this transactional related service are making big dollars. As you can read from the links below Trizetto works with many of the algorithmic formulas created by Ingenix (a wholly owned subsidiary of United Healthcare) for their reporting, “scoring” and algorithmic formulas to verify enrollment, pay claims and so on.
TriZetto Announces New Feature for Personal Health Records – Auto Populated for the Consumer But Payer Access for Eligibility Questions from Providers
As the article reads on, Trizetto is hosting the software and again these are all companies providing services that are traded on the stock market with share holder responsibility for profits and when I read their prior announcement it appears that payers have some access too, so I am not sure on how this works for privacy. As mentioned prior, the information can be exported to Microsoft HealthVault with Trizetto.
In addition Trizetto works with Ingenix (a wholly owned subsidiary of United Healthcare) to use business intelligence software to utilize additional algorithmic scoring to determine claim status.
TriZetto was purchased by Apax Partners, a London based private equity firm for 1.4 billion so somebody wants a return on their investment somewhere along this line. They also have a large agreement in the Netherlands for processing claims and other financial interests.
You can read more about what the 2 companies say about their collaboration here. One thing about all these partnerships it becomes a bit cloudy as to who is there to help create better healthcare and who is there to run formulas or algorithms on transactions to create profits on the stock market. It seems everywhere I read these days I keep seeing the algorithmic claim formulas of Ingenix involved with business intelligence with not only other insurance carriers but many of the 3rd party business consultants as well. Many of the 3rd party businesses also buy and sell your prescription medicine for data analysis from pharmacies and pharmacy benefit managers, all in the search for for data to analyze. The Trizetto page advertises “power to the employer” as shown on the image below. BD
The TriZetto Group, Inc. today announced that Chinese Community Health Plan (CCHP) has successfully implemented several TriZetto systems, including the Facets®, NetworX Pricer® and Clinical CareAdvance® applications. The products are enabling the health plan to more efficiently administer its enrollment, membership billing, claims and customer service, as well as its network and health management programs. TriZetto is managing and hosting
all of the applications for CCHP.
“For each CCHP member enrolled in a disease management program, TriZetto’s application is tracking the enrollee’s activity and providing an audit trail that helps extend the reach and benefit of CCHP’s diabetes, chronic obstructive pulmonary disease, coronary artery disease, congestive heart failure and hypertension disease management programs”
CCHP provides managed care plans for individuals & families, employer groups and Medicare beneficiaries, including those with Medicaid. CCHP currently serves more than 13,000 community members in San Francisco and Northern San Mateo County.
CCHP uses TriZetto’s Facets system as its core administrative platform to help improve efficiency, increase accuracy and reduce labor costs. TriZetto’s NetworX Pricer application helps ensure accurate and precise claims pricing. TriZetto’s Clinical CareAdvance system provides comprehensive health monitoring and reporting tools; provider and nurse-manager alerting; template-based, secure messaging between members and case managers; near real-time member identification and stratification; customized real-time statistics and reports; and outbound communication methods tailored to CCHP’s members.
CCHP implements TriZetto systems to improve its network and health management programs
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