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Upgrade to TriZetto’s Clinical CareAdvance 4.61 Supports Capital BlueCross’ Best Practices and Workflow in Care Management for Customers

DENVER – September 22, 2011 – The TriZetto Group, Inc. today announced that Capital BlueCross, the leading health insurer in central Pennsylvania and the Lehigh Valley, recently went live with TriZetto’s Clinical CareAdvance® 4.61 care management application.

The Clinical CareAdvance application combines case, disease and population management in one system to help Capital BlueCross increase administrative efficiency and promote quality care to members. For instance, the system provides support for specially trained nurses’ care coordination, which is particularly beneficial to members with more than one chronic condition or who are catastrophically ill. The system also gives case managers easy access to helpful information for member care, such as community resources and educational materials.

“The 4.61 version of TriZetto’s Clinical CareAdvance system is a welcomed resource to enhance our best-practices model,” explained Denise Fessler, vice president of clinical services at Capital BlueCross. “TriZetto’s system also helps streamline our care management processes and supports Capital BlueCross member-centric care management, such as our use of motivational interviewing techniques and Intrinsic Coaching®. Partnering with TriZetto is one more way that Capital BlueCross is demonstrating how we bring medical value – a commitment to high quality care, cost-effective care and member satisfaction – to our market.”

“TriZetto focused on mapping the product and processes to Capital BlueCross’ specific business goals for care management,” said Carolann Engler, associate vice president, care management services practice lead at TriZetto. “We carried out the Clinical CareAdvance upgrade in close consultation with them and completed the work to meet Capital BlueCross’ business goals. The go-live went smoothly, so we’re quite proud of the team’s execution.”

Capital BlueCross’ upgrade to the robust care management system is in keeping with guidance from Gartner, Inc. in a recent industry research report by the firm.

“Care management relies on technology and a business culture that focuses on a high-touch approach with members and providers to ensure that high-quality, appropriate and safe healthcare is delivered,” wrote Gartner analysts Robert Booz and Joanne Galimi. “However, many payers haven’t implemented an integrated or interoperable care management system, nor have they standardized IT platforms to support the care management process. These payers are missing opportunities to leverage technology to enhance care management. By changing an internal culture focused on manual, paper-based processes to a platform designed to support the natural workflow of care managers, financial and efficiency gains can be realized.”1

The Clinical CareAdvance application is part of TriZetto’s Clinical CareAdvance Enterprise® suite. The suite also includes the Personal CareAdvance® application for members, providing population management, and the CareAdvance ProviderTM application, offering a self-service extension of utilization management for physicians and their staff. The CareAdvance Provider product is also equipped with a Member Clinical Profile (MCP). The MCP conforms to the HL7 Continuity of Care Document industry format and provides a real-time view into the clinical information available in the CareAdvance Enterprise system. The CareAdvance Provider module will be offered as an add-on application to the Clinical CareAdvance solution.

1. Booz, Robert H. and Galimi, Joanne, “Six Strategic Imperatives for Healthcare Payers in 2011,” industry research report by Gartner, Inc., March 28, 2011.

About Capital BlueCross
Capital BlueCross is the leading health insurer in its region, providing health insurance coverage to residents in central Pennsylvania and the Lehigh Valley.

Capital BlueCross is committed to making health insurance simple for its customers and members through all the stages of life by offering nationally acclaimed customer service and a full range of innovative benefit programs for groups and individuals at competitive prices.

By establishing a culture of caring, Capital BlueCross constantly strives to do more in order to deliver more for the men, women and children who depend on the company for their health insurance needs. Capital BlueCross has been providing medical value to the people and communities of central Pennsylvania and the Lehigh Valley for more than 70 years and employs over 1,800 people in the region.

Headquartered in Harrisburg, Pa., Capital BlueCross is an independent licensee of the Blue Cross and Blue Shield Association.

About TriZetto
TriZetto provides world-class healthcare IT software and service solutions, including patented and patent-pending innovations, that drive administrative efficiency, improve the cost and quality of care, and increase payer and provider collaboration and connectivity. TriZetto solutions, many of which are patented or patent-pending, touch half the U.S. insured population and reach more than 21,000 physician practices. TriZetto’s payer offerings include enterprise and component software, application hosting and management, business process outsourcing services and consulting. Provider offerings, delivered through TriZetto’s Gateway EDI wholly owned subsidiary, include tools and services that monitor, catch and fix claims issues before they can impact a practice. TriZetto’s integrated payer-provider platform will enable deployment of promising new models of post-reform healthcare. For information, visit

Media Contacts:

Loren Finkelstein
The TriZetto Group

Davida Dinerman
Schwartz Communications

Joseph Butera
Capital BlueCross
(717) 541-6139