Large Managed Medicaid Plan Launches Dual-eligibles Program Anchored by Jiva Population Health Management Platform from ZeOmega

Payer’s New Program to Help More Than 1 Million People in Disabled and Low-income Populations

PLANO, Texas – Sept. 1, 2015 – ZeOmega® Inc., a market leader in population health solutions, today announced that one of the country’s leading healthcare plans serving low income and disabled populations has expanded its use of ZeOmega’s Jiva™ platform with the rollout of its new dual-eligibles program. Operating in 16 states and the District of Columbia, the managed care organization specifically focuses on the health needs and services of underserved populations.

The payer, which has been operating for more than 30 years, currently serves 2 million members through a network of more than 20,000 providers, and focuses on a wide array of beneficiaries, particularly those with complex and chronic-care needs. The payer has used ZeOmega’s Jiva population health platform for the past three years across its nine Medicare and Medicaid plans and multiple third-party arrangements (TPAs) to deliver utilization management, care management and disease management services to more than 1 million people.

According to the Medicare-Medicaid Coordination Office (MMCO), between 2006 and 2013, the total number of dual-eligible enrollees increased by 24 percent, from 8.6 million to 10.7 million. As the number of low-income seniors in need and younger people with significant disabilities grows, healthcare organizations are implementing technologies to deliver critical services to these vulnerable populations.

Based on its prior Jiva success, the payer turned to ZeOmega to help it expand into the growing dual-eligibles market.

According to the payer’s vice president of corporate medical management: “Serving complex populations like the duals is challenging because behavioral and other psychosocial determinants play a larger role here than in other populations. Jiva’s capabilities enable us to serve such complex populations by not only personalizing care based on the psychosocial determinants of health, but also bringing a broader multidisciplinary care team together around the care for such individuals. Given Jiva’s capabilities to support the complex populations and our track record of using Jiva to manage all our other populations, using Jiva as we expand into the Medicare/Medicaid Demonstration programs was a natural choice.”

One of the states in which this payer operates is Michigan, where an increasing number of individuals are qualifying as dual-eligible beneficiaries. The company was selected by Michigan’s Department of Community Health and approved by the Centers for Medicare and Medicaid Services (CMS) to start serving the state’s dual eligibles starting on May 1, 2015, giving it a very tight timeline to deploy the technology necessary to begin the service.

In order to help the payer meet its deadlines, ZeOmega implemented the newest version of Jiva in less than 90 days, enabling the organization to serve thousands of qualified dual eligibles in Wayne and Macomb counties. The payer’s TPAs also use Jiva without compromising data integrity and HIPAA regulatory requirements, a key concern for all entities involved in working in this dual-eligibles program.

With Jiva, the payer met its need for one comprehensive platform with a provider portal that can execute all types of care, particularly disease management and care management. The Web-based Jiva platform can be accessed from both the field and the office, which was one of the payer’s key objectives in its efforts to support dual-eligible members.

“This managed care organization is a proven leader in delivering essential healthcare programs to those populations who need it the most, and they do this through innovative approaches including leveraging community resources to improve the health of the disadvantaged,” said Nandini Rangaswamy, executive vice president and chief strategy officer for ZeOmega. “We are excited to expand our partnership with this company as they embark upon a new program to serve dual-eligible populations across several states. The rapid Jiva rollout in Michigan is yet another data point that demonstrates how quickly Jiva can be implemented for healthcare organizations serving diverse populations.”

By transitioning to Jiva as its one unified and integrated platform to facilitate all types of care, the payer expects even higher productivity and streamlined reporting to accommodate its dual-eligibles business expansion. The expanded Jiva use includes single sign-on (SSO) integration with two different provider portals, while auto-approval and auto-assignment configurations through Jiva will help the payer grow and manage the configuration at its multiple lines of business.

As a result of the recent expansion, the payer is now using Jiva for its entire care-management division supporting Medicaid, Medicare and dual eligibles, with 1,400 concurrent Jiva users and the flexibility and configurability to handle many more as the payer expands its offerings.

About ZeOmega
ZeOmega’s powerful population health platform delivers high-value, strategic solutions enabling payers and care-delivery organizations to improve individual health and provider performance. With deep domain expertise and a comprehensive understanding of complex population health challenges, ZeOmega serves as a true-north partner for clients, offering flexible deployment and delivery models that leverage an innovative platform designed to integrate workflow, analytics, content and communication capabilities. By consistently meeting customer expectations and project benchmarks, ZeOmega has earned a reputation for responsiveness and reliability. For more information, visit or call 214-618-9880. Follow ZeOmega on Twitter, LinkedIn or Facebook.

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