TriZetto announces general availability of health benefits administration and incentive management software

Aug 12 2010

The TriZetto Group, Inc. today announced the general availability of its Value-Based Benefits Solution, health benefits administration and incentive management software that enables healthcare payers to customize benefits and provide incentives for individual members based on their health status, chronic conditions, and health and wellness activity.

“which eases participation in health risk assessments and programmatic interventions that can help manage member health”

TriZetto's Value-Based Benefits Solution enables administration of value-based insurance designs that leverage the company's Facets^TM and QNXT^TM enterprise administration systems, which are used by 137 health plans to provide coverage to 107 million Americans.

"Our automated solution is a response to the challenge of improving quality and cost for the American consumer," said Jeff Rideout, M.D., TriZetto's senior vice president of care and cost management and chief medical officer. "Studies show that blunt cost-control measures can discourage effective, necessary care, particularly among those with chronic conditions. By contrast, value-based solutions reward compliance and healthier choices, and can improve both the quality of care and clinical outcomes. Value-based-insurance design and TriZetto's Value-Based Benefits Solution are vital, especially given that 60 percent of chronically ill patients have difficulty adhering to evidence-based treatments."

"We are excited to deliver this powerful tool to our customers," said Dan Spirek, TriZetto's executive vice president and chief strategy and marketing officer. "The Value-Based Benefits Solution is another important component of TriZetto's broad strategy to create solutions to help better align information and incentives across members, providers and employers."

In its simplest, most prevalent form, value-based insurance products target specific drugs for chronic conditions for co-payment reduction, thus removing barriers to medication adherence for patients.

"TriZetto's solution can certainly handle basic value-based design requirements, but it also can provide value-based insurance designs in advanced forms, including multiple incentives that are member- and condition-specific," explained Gail Knopf, vice president of enterprise strategy at TriZetto. "Our Value-Based Benefits Solution targets patients with select clinical diagnoses and lowers co-payments or coinsurance for specific, high-value medical and pharmacy services as consumers take positive action, not at some fixed point in time such as open enrollment. If desired, enhanced benefits take effect only after the patient has completed online education on his or her condition or has spoken with a health coach or disease manager. TriZetto's product automates what historically has been a very labor-intensive, individualized adjudication of medical claims. A variety of incentives can be offered to engage the patient at each step, from health assessment through the care process."

TriZetto's Value-Based Benefits Solution includes a web application that gives healthcare payers the ability to:

• Configure and manage incentive programs,
• Manage members in programs and log compliance,
• Enable claims adjudication of member-specific value-based benefits in TriZetto's Facets and QNXT enterprise systems, and
• Communicate with third-party health and wellness, and reward vendors.

"The benefits of the payer web application are two-fold: The solution helps drive positive behavior change by members," said Knopf, "which is where the rubber meets the road."

In addition, the functionality reduces barriers to member compliance with regular office visits, medications and other proven, best-practice instructions from practitioners, which in turn can help avert more expensive, acute care.

TriZetto's Value-Based Benefits Solution also includes a web application that provides members the online ability to:

• View incentive program details and available rewards,
• Enroll in applicable programs,
• View incentive program activity, and
• Link to program and reward vendors.

This member web application encourages healthy choices and patient compliance. The one-stop portal provides members with what they need - through reward redemption - "which eases participation in health risk assessments and programmatic interventions that can help manage member health," Knopf said.

Through a partnership with Hallmark Business Connections, a subsidiary of Hallmark Cards, TriZetto's Value-Based Benefits Solution automates online gift card selection from hundreds of leading retailers. Additionally, TriZetto's Value-Based Benefits Solution is available with optional templates of benefit designs for those chronic conditions which drive the greatest claim costs. The templates are created exclusively for TriZetto by A. Mark Fendrick, M.D., and Michael Chernew, Ph.D., of the Value-Based Insurance Design Institute, LLC. Drs. Fendrick and Chernew are widely acknowledged to have founded the value-based insurance design movement more than a decade ago. The initial benefit design templates include diabetes, coronary artery disease, asthma, smoking cessation and depression. The templates are pre-configured in the Value-Based Benefits Solution and Facets and QNXT applications.