Optum Teams with Medecision, TriZetto on New Offering to Streamline States' Medicaid Management Information
Systems
- 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claims more efficiently, and retire outdated legacy systems in favor of more flexible, modular, “efficient and consumer-friendly”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 Optum
Optum 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 Medecision
Leading 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 Company
TriZetto, 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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Optum Communications
Steve Puleo, 781-419-8553
steve.puleo@optum.com
or
Medecision
Sherri Stuart, 484-323-2692
Senior Vice President, Marketing Services
sherri.stuart@medecision.com
or
For TriZetto and Cognizant
Alison Cizowski, 617-399-4914
Text100
alison.cizowski@text100.com
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