QualChoice Health Insurance Taps TriZetto’s Payment-Bundling Solution

The TriZetto Group announced that QualChoice Health Insurance, a managed care company, is using TriZetto software to administer episode-based payments to physicians who provide cardiac stents, perinatal care and hip and knee replacements for its group and individual health plan members.

In a release dated Aug. 22, the Company said that under the new payment model, physicians and facilities will share cost savings or incur performance penalties, based on how well they complete episodes of care at appropriate cost and quality levels.

QualChoice is partnering with Medicaid, other private payers and hundreds of physicians, healthcare professionals and other stakeholders to implement the Arkansas Health Care Payment Improvement Initiative, which began on July 1. Participants in the state-sponsored program use an episodic-payment model.

"QualChoice chose TriZetto's payment-bundling administration solution because it automates and streamlines retrospective and prospective episodic-payment models," said Michael Stock, president and CEO of QualChoice. "Under the state program, physicians and facilities are rewarded retrospectively - months after the service - with shared savings for meeting quality and cost standards for select episodes of care. Beginning in 2013, however, QualChoice will have the ability to reward providers prospectively - with immediate cost savings - for meeting quality and cost targets. TriZetto's highly flexible solution, which we implemented in just three months, will support both retrospective and prospective payment models, allowing us to continually innovate to improve member health and best serve our employer customers.

"QualChoice continues to demonstrate tremendous foresight and leadership. QualChoice knows the future of U.S. healthcare lies in value-based reimbursement, not in the current fee-for-service model driving unwarranted variations in care that compromise member health and increase costs. Our payment-bundling administration solution will support QualChoice as it collaborates with providers to improve the health of Arkansans."

TriZetto's payment-bundling application automates and streamlines the processing of episode-of-care payments by QualChoice.

QualChoice is the brand name for products and services provided by QCA Health Plan and QualChoice Life and Health Insurance Company.

QualChoice is a health services company.

TriZetto provides information technology and service solutions.

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