Santa Clara Family Health Plan Prepares for Growth with Cognizant’s TriZetto Platform

The plan will consolidate three plans on the TriZetto to improve operational efficiency and compliance, lowers costs and improves member and provider experience.

(Lick Observatory in Santa Clara County, Calif. Photo credit: Michael, the_tahoe_guy.)

Santa Clara Family Health Plan (SCFHP, Campbell, Calif.) has selected Cognizant’s (Teaneck, N.J.) TriZetto software solutions to support the overall administration of its business operations on a single, modern healthcare platform designed for efficiency, flexibility and improved member and provider experiences, the vendor reports. The implementation expands and existing relationship between SCFHP and Cognizant/TriZetto.

SCFHP is a local safety net health plan serving Santa Clara County, California, has the mission of providing affordable health insurance to more than 280,000 members in its three lines of business: Medi-Cal, Healthy Kids, and Cal MediConnect. Medi-Cal is California’s Medicaid program, Healthy Kids is a locally funded insurance program, and Cal MediConnect is a Medicare-Medicaid plan for dual eligible beneficiaries.

SCFHP, with help from Cognizant’s services arm, will implement TriZetto’s QNXT enterprise core administration platform to support its Medi-Cal and Healthy Kids programs beginning in June 2017, the vendor reports. The implementation will put SCFHP’s Medi-Cal and Healthy Kids programs on the same platform as its Cal MediConnect program. The TriZetto QNXT solution, which widely deployed for Medicaid Managed Care Organizations in the U.S., will provide SCFHP with the ability to run multiple lines of business on a single platform, ensure compliance, streamline operations, reduce costs and improve customer experience, the vendor asserts.

As an existing TriZetto client, SCFHP will migrate the data of its 280,000 Medi-Cal and Healthy Kids members to the QNXT platform, with the aim of improving operational efficiency and providing new flexibility in the evolving healthcare marketplace, the vendor says. The new platform will also enable SCFHP to streamline the management and processing of grievances, appeals and complaints, Cognizant says.

Krish Venkat, President, Healthcare and Life Sciences, Cognizant.

Krish Venkat, President, Healthcare and Life Sciences, Cognizant.

Quality Customer Service, Meeting Changing Compliance Demands

“As the healthcare industry continues to grow in complexity, it is essential to leverage proven solutions that can efficiently manage health plan operations, but also meet changing industry regulations and compliance,” comments Jonathan Tamayo, CIO, Santa Clara Family Health Plan. “TriZetto’s solutions suite and Cognizant’s expertise will help us meet business requirements, while supporting our commitment to providing the highest quality customer service to our members.”

Leveraging digital technologies and modern infrastructures is crucial for organizations to remain compliant, while driving success in today’s changing healthcare landscape, observes Krish Venkat, President, Healthcare and Life Sciences, Cognizant. “Our integrated consulting, software and IT solutions will help SCFHP streamline business growth and workflow, and provide improved experiences across the care continuum.”

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Anthony R. O’Donnell // Anthony O'Donnell is Executive Editor of Insurance Innovation Reporter. For nearly two decades, he has been an observer and commentator on the use of information technology in the insurance industry, following industry trends and writing about the use of IT across all sectors of the insurance industry. He can be reached at [email protected] or (503) 936-2803.

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