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systems, which El Paso uses. El Paso and TriZetto were able to work together to assess the situation, create a plan to evaluate El Paso’s systems and business processes within the short time frame and then deploy a large group of profession- als to get the job done.


me and sion-


Once that first planning step was completed, the joint El Paso- TriZetto work team dug in to evaluate all aspects of El Paso’s business – from core administra- tion to provider contracting to customer support – to determine where 5010 and ICD-10 require- ments might have an impact. Not surprisingly, the answer was “nearly everywhere.” While El Paso knew the mechanics of how 5010 and ICD-10 would impact obvious areas, such as claims technology, TriZetto was able to help identify areas that were less obvious: moving staffi ng from one area to another for a temporary time frame, for example, or engaging in provider contracting sooner rather than later.


p y he D-10


The 5010 and ICD-10 compliance process requires nothing short of enterprise- wide evolution, giving health plans the tools they need to exploit new opportunities in administrative effi ciency and cost and quality of care.


Third, El Paso used their state-mandated 5010 com- pliance plan, as well as the ICD-10 plan they created, in tandem. This approach provided a strategic roadmap for the entire organization. El Paso learned that if a health plan prepares for the changes soon enough, evaluating all business op- erations at one time, the value derived from the new code sets could be monumental. Better care management, more effi cient disease management and


Sharon Perkins is director of information technology, El Paso First Health Plans, and Greg Larson is associate vice president of services product management, The TriZetto Group. For more information on TriZetto solutions: www.rsleads.com/012ht-204


more cost-effective administrative techniques were just the tip of the iceberg.


By embracing the challenges of 5010 and ICD-10 compliance, El Paso was able to create a new way of doing business that is more effi cient and data driven


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than before. The plan El Paso submitted to the state of Texas was accepted as delivered in the fi rst round, with no fi ndings or recommended changes. The state made positive comments that the plan was solid and had no remediation issues or gaps. In addition, El Paso’s CEO approved the compliance plan as the offi cial “marching orders” for the entire organization with no changes.


state m plan iss


C The joint effort between


TriZetto and El Paso First Health Plans – to evaluate the entire busi- ness from top to bottom, looking at ways ICD-10 and 5010 could impact even the least likely business unit – proved to be a valuable path for change and growth. It enabled El Paso to move forward with a clear course to follow for change and allowed the company to maximize the coming regulatory changes for the business.


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Visit www.rsleads.com/012ht-006 HEALTH MANAGEMENT TECHNOLOGY December 2010 27


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