Here’s my favorite word once more, algorithms (grin). I say that as anyone who reads this blog runs right into that word many times over, the formulas used by software to aggregate and report for decision making processes. In short, the software solution is a tool to keep on top of members needs, labs, utilization (how many services are you using) and provide alerts, so in essence a tool for “utilization managers”, that work for the various health plans, to ensure physicians are providing the best care at the lowest cost and to ensure medical alerts for patient conditions are not overlooked, in the area of prevention and/or management, so if you are a participant with a chronic condition, this is the software that everyone will be using to see how, where, why, and how often you are seen and treated.
Once again, the two hottest trends in healthcare are whistleblowers and algorithms, as they both generate huge sums of money for someone. BD
NEWPORT BEACH, CA – CareMore Health Plan, Inc. has gone live with TriZetto's Clinical CareAdvance application to help manage members' acute and chronic illnesses and improve health status across its member population.
CareMore Health Plan provides Medicare Advantage health plans for 32,000 seniors, largely in key markets in California. TriZetto provides software and IT services that help payer organizations move toward integrated healthcare management - the convergence of benefits administration, care management and constituent engagement. TriZetto's care management application applies clinical algorithms that create targeted interventions to help improve members' health. The Clinical CareAdvance platform is based on flexible business rules that incorporate claims data, utilization measures, diagnostic triggers and optional data sources such as laboratory, biometrics and pharmacy.