Amid concern that smaller health plans don’t have access to or funding for software and services, The TriZetto Group has launched QNXT Essentials.
The software and services package is designed specifically for plans with fewer than 50,000 members, say officials of the Newport Beach, Calif.-based company. It includes the company’s QNXT enterprise administration system, accelerated product implementation and full-service application hosting and management services, as well as the company’s new member and provider service real-time portal applications, and is designed for a six-month deployment.
“Just like their larger counterparts, smaller health plans require robust business functionality and technical capabilities,” said Rob Scavo, TriZetto’s senior vice president of core administration systems. “Unlike larger payers, emerging plans often have neither the same level of resources and expertise to manage their core administration systems nor the ability to make large upfront investments. With QNXT Essentials, we’re arming these payers with a proven solution, enabling them to compete at the same level.”
Among the first clients for QNXT Essentials was the MD Care Healthplan, a new health plan based in Signal Hill, Calif. and serving 8,000 Medicare patients in Los Angeles, Orange and Riverside counties. MD Care will go live with QNXT Essentials next year, at about the same time it expands into San Bernardino County. Company officials said they were looking for a platform that would allow them to design their own plans, improve efficiency and comply with the Centers for Medicare and Medicaid Services’ requirements and 5010/ICD-10 mandates.
“We wanted greater efficiency and automation in our claims adjudication and other operations, and we sought a solution that would allow us to enter the game at a lower price and scale with membership growth,” said Don Phan, MD Care’s chairman. “With QNXT Essentials, we get the best of all worlds – a proven platform, rapid implementation and expert application hosting – without major upfront investment. We believe QNXT Essentials will enable us to quickly achieve our business goals and compete toe-to-toe with much larger plans.”
According to Janice Young of IDC Health Insights, smaller health plans need help migrating from their legacy systems to newer, more advanced platforms.
“There is an inflection point at which investment in the older applications produces much less value than investment in newer technologies and/or newer technology delivery and management strategies,” she wrote in a June 2009 white paper sponsored by TriZetto. “Most small healthcare payers have likely reached or will shortly reach this inflection point. … Most will find a need to migrate to newer, more agile environments, particularly those that support strong integration, Web services and information management. Many healthcare payers will seek greater partnerships, if not outsourcing, for service, support and maintenance.”