- First-to-market, customizable approach
will enable states to purchase only the information technology and
clinical services they need, and avoid costly, time-consuming
inflexible systems
- Comprehensive solution to provide
claims processing, data warehousing and care management
offerings
Optum is teaming with Medecision and TriZetto to launch a
first-to-market services-based offering for states’ Medicaid
Management Information Systems (MMIS), the critical IT foundation
of the public health program for low-income people.
The new Optum Medicaid Management Services (OMMS) solution is a
Software-as-a-Service (SaaS) and Business Process-as-a-Service
(BPaaS) model that will enable Medicaid agencies to purchase only
the IT, administrative and clinical services they need to
effectively manage their programs – rather than buying costly and
inflexible systems that often take several years and tens of
millions of dollars to install and operationalize, and sometimes
result in cost-overruns or outright failures.
“The Optum solution is analogous to states purchasing the
electricity they need rather than building the entire power plant,”
said Steve Larsen, executive vice president, Optum Government
Solutions. “Our state Medicaid clients have told us that
traditional MMIS program administration approaches – now more than
three decades old – needed upgrading to reflect the fast-paced
environment and their broadened responsibilities under the
Affordable Care Act; they welcome this modern, modular,
services-based alternative.”
A recent rule change by the Centers for Medicare & Medicaid
Services (CMS) provides enhanced federal funding for Medicaid
eligibility and enrollment systems, as well as MMIS claims systems,
if they help automate application and renewal tasks, process claims
more efficiently, and retire outdated legacy systems in favor of
more flexible, modular, “efficient and consumer-friendly”
solutions. The Optum services-based solution and the CMS
rule-change now enable state Medicaid agencies to avoid the
unwieldy IT implementation processes that accompany massive
end-to-end MMIS system installations, and concentrate on their
primary mission of improving the health outcomes of their
beneficiaries – a goal that is becoming increasingly critical as
Medicaid programs expand coverage in many states.
States that purchase services instead of setting systems
requirements can benefit in numerous ways, including a shortened IT
implementation period with less cost and reduced risk; more choices
from proven commercial solutions that already work in the
marketplace; improved administrative operations; and access to new
technologies and cloud-based approaches that help agencies operate
more flexibly.
Optum estimates that its SaaS approach could cut by as much as
half the timeframe for new MMIS implementations, thereby
significantly reducing the time and cost of implementation, and
containing operational costs in both the short and long term.
Optum currently provides clinical, analytical, consulting, data,
and technology solutions to 37 state Medicaid agencies and the
District of Columbia. It will incorporate into its new solution
Medecision’s extensive population health management expertise,
anchored by its flagship Aerial™ solution that supports best
performance in meeting quality measures, integration of behavioral
health with traditional health care management, and management of
community-based services; and TriZetto’s broad Medicaid claims and
administrative platform, Facets™, which manages claims for nearly
30 percent of the Medicaid members who are covered by managed care
organizations (MCOs).
“Medecision’s people and technology help power the care that
millions of American beneficiaries receive under Medicaid plans
throughout the United States,” said Deborah M. Gage, president and
CEO, Medecision. “We focus on delivering compliant, community
care-based applications that integrate behavioral and medical care
decision support so that Medicaid beneficiaries receive optimal
benefits. Through OMMS, we are proud to be part of delivering
affordable, effective solutions that contribute to a healthier
population.”
“The expansion of managed Medicaid will be significant in the
coming years, as the government continues to be the largest source
of newly insured lives in the marketplace,” said Krish Venkat,
president, Healthcare and Life Sciences of Cognizant, parent
company of TriZetto. “Platform-based solutions with flexible,
as-a-service delivery models will be vital for health care
organizations to address the demands of this growing market. We are
pleased to team with Optum to bring the powerful and flexible
capabilities of the Facets platform to the Optum Medicaid
Management Services solution.”
Traditionally, MMIS systems – which process Medicaid
fee-for-service claims and managed care encounters, and provide
reporting on the program – are formally certified by CMS. Such
certification enables states to access enhanced matching federal
funds at the rate of 90 percent for design, development and
implementation, and 75 percent for operational expenses.
With Optum’s new solution, states will structure their request
for federal matching funds in the form of business services rather
than system requirements. CMS auditors would certify that all
services requested by the state and approved by CMS have been made
available, and then make federal matching funds available to the
state.
The Optum solution provides states the following:
- Business services, such as Medicaid
fee-for-service claims processing, care provider enrollment, call
center activities and operations reporting.
- Analytics and data warehousing services
that can use data to help states identify needs across their
population, focus resources accordingly to improve outcomes, and
measure the performance of care providers, health plans and new
state-managed programs to improve care.
- Health services such as wellness and
care management programs to improve the health of Medicaid
fee-for-service recipients.
In conjunction with the launch of its new solution, Optum has
received certification from CMS as a “Quality Improvement
Organization (QIO)-like” entity, a designation that enables it to
perform quality improvement initiatives, and review cases and
analyze patterns of care related to quality measures and medical
necessity. The QIO-like designation allows states to receive 75
percent federal matching funds when Optum performs these
services.
About OptumOptum is a
leading information and technology-enabled health services business
dedicated to helping make the health system work better for
everyone. With more than 100,000 people worldwide, Optum delivers
intelligent, integrated solutions that help to modernize the health
system and improve overall population health. Optum is part of
UnitedHealth Group (NYSE:UNH).
About MedecisionLeading
Medicaid MCOs and Medicare Advantage plans depend on Medecision’s
team of experienced professionals and modular suite of Aerial™
integrated medical management, data aggregation and analytics,
member engagement and Medicaid and Medicare-specific compliance
solutions to power their population health management strategies
and confidently grow their businesses. Medecision focuses on
delivering compliant, community care-based applications that
integrate behavioral and medical care decision support to help
millions of American Medicaid and Medicare Advantage beneficiaries
receive optimal benefits, while helping to control the cost of care
with better utilization management and clinical best practices.
www.medecision.com
About TriZetto, a Cognizant
CompanyTriZetto, a Cognizant (NASDAQ: CTSH) company and
business unit within Cognizant’s Healthcare and Life Sciences
practice, provides world-class information technology and service
solutions that help payers and providers work more efficiently and
collaborate to deliver better health. Working with more than 350
health plans, TriZetto’s technology solutions touch over half of
the U.S.’s insured population and reach more than 260,000 care
providers.
TriZetto’s world-class technology products, in combination with
Cognizant’s consulting, IT, and business process services,
dramatically simplifies the deployment and adoption of technology
and improves operations. For more information, visit
http://www.trizetto.com
TriZetto and the TriZetto triangle logo are registered
trademarks and Facets is a trademark of the TriZetto
Corporation.
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version on businesswire.com: http://www.businesswire.com/news/home/20160504005342/en/
Optum CommunicationsSteve Puleo,
781-419-8553steve.puleo@optum.comorMedecisionSherri Stuart,
484-323-2692Senior Vice President, Marketing
Servicessherri.stuart@medecision.comorFor TriZetto and
CognizantAlison Cizowski,
617-399-4914Text100alison.cizowski@text100.com
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