• E-mail
• Print
• Comment
• Font Size
• Digg
• del.icio.us
• Discuss article

Tailored Care Management Programs Are Key to Payers Managing Highly Complex and Rapidly Growing Senior Populations

Posted on: Tuesday, 2 September 2008, 09:00 CDT

Today's payers face a perfect storm of converging forces: a rapidly growing Medicare population, a Medicare population that increasingly suffers from multiple chronic conditions and growing competition for Medicare members prompted by higher reimbursements under the Medicare Prescription Drug, Improvement and Modernization Act of 2003. According to research by the National Institutes of Health, 82 percent of Medicare beneficiaries age 65 or older have one or more chronic conditions and 65 percent have multiple chronic conditions.(1) Senior members are also more likely to have geriatric syndromes such as dementia that can complicate the management of chronic conditions.(2)

"Medicare beneficiaries need more care because of their chronic illnesses," said Michael Cantor, MD, JD, a geriatrician who helped The TriZetto Group develop its CareAdvance Medicare(TM) care management application. "Without effective care management programs tailored to the needs of seniors, health plans are taking on substantial risks, namely leaving gaps in services and the continuum of care and the potential breakdown of self-management of chronic conditions by members."

TriZetto's CareAdvance Medicare system is specifically designed to manage Medicare Advantage members, including those with multiple chronic conditions. Its tools and functionality go beyond Medicare-specific health-risk assessments to include Medicare-specific content, interventions and member identification and stratification tools that help payers monitor health risks, health status and care of Medicare members. Timely and accurate identification and management of chronically ill members, according to research, can improve clinical outcomes and control claim costs.

Further information on the successful care management of senior populations is published in two TriZetto white papers entitled, "Achieving Return on Investment With Care Management of Your Senior Population" and "The Value of Care Management for Medicare Advantage Plans," available by request at salesinfo@trizetto.com. Requests by news media for the white papers and for interviews may be directed to Schwartz Communications at 781-684-0770 or trizetto@schwartz-pr.com.

About TriZetto

TriZetto is Powering Integrated Healthcare Management(TM). With its technology touching more than half of the U.S. insured population, TriZetto is uniquely positioned to drive the convergence of health benefit administration, care management and constituent engagement. The company provides premier information technology solutions that enable payers and other constituents in the healthcare supply chain to improve the coordination of benefits and care for healthcare consumers. Healthcare payers include national and regional health insurance plans, and benefits administrators that provide transaction services to self-insured employer groups. The company's payer-focused information technology offerings include enterprise and component software, hosting and business process outsourcing services, and consulting. Headquartered in Newport Beach, Calif., TriZetto can be reached at 949-719-2200 or at www.trizetto.com.

(1) Findings from "Prevalence, Expenditures, and Complications of Multiple Chronic Conditions in the Elderly," by Wolff JL, Starfield B, Anderson G; Academy for Health Services Research and Health Policy Meeting, 2002. (2) "Achieving Return on Investment With Care Management of Your Senior Population," white paper by The TriZetto Group, Inc., Oct. 11, 2007, p.1.

Source: Business Wire

More News in this Category