Healthcare Vision Blog

  • Best Practices: How Did CNIC Health Solutions and TriZetto Collaborate on a Critical Strategic Initiative?

    "My mission is to provide world class delivery to our customers integrated across consulting, hosting, application services and business process outsourcing around TriZetto software. In this monthly forum,  The New Healthcare C-Suite: Emerging Models in Best Practices , I'll be highlighting best practices adopted by health plans and other payers as our healthcare industry continues its evolution. We'll look at how today's C-Suite is taking a more active role in technology strategies and discover why some of these healthcare leaders are achieving results that exceed industry norms."  

    By: Cem Tanyel | Jun 08, 2016

    Third party administrators (TPAs) differ from health plans in that they do not carry risk. TPAs serve their clients by developing, managing and administering self-funded health plans—i.e., plans whose primary claims are paid from a pool of funds set aside by the plan sponsor itself (generally an employer).

    I had the opportunity to speak with Brian Seigal, Director of Claims and Customer Service at CNIC Health Solutions, Inc. about a recent strategic initiative approved by the Colorado-based TPA. We discussed how the CNIC team collaborated with TriZetto to implement system solutions that supported the initiative to further evolve CNIC’s service model.

    “CNIC had historically provided highly customized TPA administrative services for complex benefit and network arrangements. Our new initiative was to provide more standardized offerings alongside our fully customized arrangements,” Brian noted. “We wanted to enhance scalability and efficiency while retaining flexibility.”

    Brian mentioned that, when he had started with CNIC three years ago, the company was in the process of renewing its TriZetto QicLink contract. CNIC was evaluating whether a short-term or long-term renewal would best meet its business needs. During the negotiation process, TriZetto recommended that their consulting team perform an operational assessment. CNIC agreed, giving the team carte blanche to interview staff members and evaluate the TPA’s core administration processes.

    When I asked Brian why they pursued the assessment, he told me, “We looked at it as an opportunity to ensure that we were taking full advantage of all QicLink capabilities. Since the system is so customizable, different clients use it in significantly distinct ways, and we wanted to make sure we were selecting the most effective options available to support our enhanced service model.”

    Brian also understood from past experience that this type of analysis can easily end up just sitting on a shelf. He offered these best practices recommendations:

    1. Know your organization and your challenges.
    2. Ensure that you have full support from the highest levels of management from the beginning of the project.
    3. Go into the project with an open mind, fully considering all recommendations, even those that change the way you currently conduct your operations.
    4. Prepare your team to effectively evaluate and act on the recommendations you receive.

    “You have to be really honest with yourself before you invite partners to collaborate,” Brian noted. “You need to be thorough in identifying your challenges so you can bring direction to that process and make it truly meaningful and valuable. Not only did we choose to do an operational assessment, we brought the right level of direction and leadership to it. We also did a good job of prepping our teams to act on the recommendations that we ultimately selected for implementation.”

    “Once we received the assessment recommendations, we quickly delivered an action plan that would enable our teams to fully evaluate recommendations, perform a candid assessment of where it made sense to evolve our business model versus where we elected not to make changes, and to effectively implement those recommendations we chose to adopt. We had team players in place to capitalize on momentum and keep the project moving.” Brian added, “In some cases, we elected to use TriZetto consultants to assist us in implementing recommendations, in order to achieve the most efficient and timely results.”

    Lessons Learned

    When I asked Brian what he and his team would do differently, he mentioned staff preparation. “While we were thrilled with the results we achieved,” Brian noted, “we could have better maximized our time by prepping our staff a bit differently.”

    “We were very candid with the assessment team about some of the most significant challenges we faced in our initiative to enhance our service model,” Brian added. “However, we missed out on opportunities to get greater clarification on some secondary and tertiary level questions. If you really want your vendor to help you achieve greater operational excellence, you need to prepare in advance in order to go into as much depth as possible, or you’re going to miss out on some potential value.”

    A Final Comment

    Brian had one final best practice recommendation to share with me before we concluded our conversation. “Ensure that you are taking full advantage of all system capabilities when evaluating new business strategies. It can be a very worthwhile endeavor to learn how the system and your vendor partner can efficiently and effectively do some of the heavy lifting for you.”

    CNIC Health Solutions, Inc. engaged TriZetto Consulting Services to perform an operational assessment of their QicLink core administration system. By implementing the recommendations made in the assessment, CNIC’s automation levels improved 34 percent in specific areas, and the TPA was able to standardize key processes while retaining plan customization, flexibility and accuracy. CNIC has seen significant benefits from a strong, interactive partnership with TriZetto.


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    Written by: Cem Tanyel
    Chief Services Officer, Senior Vice President, Consulting and Delivery


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