TriZetto Launches Automated Payment Bundling Solution for Healthcare Payers to Help Reduce Costs and Improve Quality

Optional PROMETHEUS Payment Bundle Designs Available Through Agreement With Health Care Incentives Improvement Institute

GREENWOOD VILLAGE, Colo.--(BUSINESS WIRE)-- The TriZetto Group, Inc. today announced the launch of its NetworX Payment Bundling Administration^TM application for health plans, employer consortia and third-party administrators. TriZetto’s new patent-pending product automates the processing of episode-of-care payments, including the unique feature of a single prospective payment to a group of clinicians and hospitals for all the medical services during an episode of care.

A growing body of evidence suggests that payment bundling, one form of value-based reimbursement, can help reduce costs for healthcare payers, improve profit for clinicians and hospitals, and enhance the clinical outcomes and satisfaction of patients. Recent healthcare reform legislation calls for the development of payment-bundling programs.

“The catch has been that healthcare payers have had to administer payment bundling manually, which is not sustainable for scaled deployment of this highly promising model of clinician reimbursement,” said Jeff Rideout, M.D., senior vice president and chief medical officer at TriZetto. “Automation, now possible with TriZetto’s NetworX Payment Bundling Administration solution, will ease a payer’s deployment of value-based reimbursement across its network.

“Automated payment-bundling software is a smart investment by payers for at least three reasons,” Rideout added. “One, unlike many investments, payment bundling can deliver ROI immediately through lower, recontracted costs for medical services.

Two, at least some of the investment in payment bundling can be treated favorably – as a medical expense – under medical-loss ratio rules of the healthcare reform law, as long as quality measurement and improvement targets are included in the design features. And third, industry research suggests that payment bundling is a stepping stone toward accountable care organizations, an emerging model of healthcare that payers will deploy in months and years to come.”

TriZetto’s NetworX Payment Bundling Administration application pre-integrates with TriZetto’s Facets^TM core enterprise administration system and the company’s NetworX Pricer^® network management application. Integration with TriZetto’s QNXT^TM core system will come in 2012. The NetworX Payment Bundling Administration solution also is designed to integrate with any third-party and homegrown core system that provides the necessary web services.

The application automates the bundled payment of 10 common episodes of care, including heart bypass surgery, knee replacement, hip replacement and select outpatient procedures. These definitions were created by national entities, including the Centers for Medicare and Medicaid Services and Integrated Healthcare Alliance of California. Further, TriZetto’s product gives customers the ability to modify or add their own bundle designs.

TriZetto offers an option of more than 20 additional pre-configured payment bundles for heart attack, stroke, pneumonia, diabetes, asthma and other chronic conditions through a licensing agreement with the Health Care Incentives Improvement Institute^TM, Inc. (HCI3). Funded by the Robert Wood Johnson Foundation, the Colorado Health Foundation and others, HCI3 is a non-profit organization that manages and implements the PROMETHEUS Payment^® model and its Evidence-informed Case Rates(ECR^®), which are comprehensive episodes of care for which services are bundled together.

“Our payment-bundling partnership with TriZetto is a win-win-win for payers, providers and patients,” said Francois de Brantes, HCI3’s executive director. “Bundling services that are defined as constituting a comprehensive episode of care can cut payers’ claim costs, and it encourages caregivers to work in teams, share information and take collective responsibility for a patient's health. This approach provides a realistic framework to transform today's fragmented and inefficient system into one that is far more integrated and accountable.”

“TriZetto’s NetworX Payment Bundling Administration application uses business logic and a rules engine to automate the definition of bundles and payments for episodic care,” explained Jay Sultan, TriZetto’s associate vice president and product manager of value-based reimbursement, who leads the initiative. “The system bundles related fee-for-service claims by multiple clinicians for a heart bypass, for example, which might include an emergency-room visit, an inpatient stay, rehabilitation and primary care. Through repricing, the related claims are paid as a single bundled payment to an administrative provider, who then reimburses all practitioners involved in the episode of care.”

TriZetto’s NetworX Payment Bundling Administration solution is available to healthcare payers on a licensed or hosted basis. The company also plans to expand its payment-bundling solution to include an offering for provider risk-bearing organizations.

The NetworX Payment Bundling Administration system is part of TriZetto’s NetworX Suite^®, a comprehensive network management solution that helps healthcare payer organizations attain greater value for every healthcare dollar spent, from contract modeling and analysis through claims pricing. The NetworX Suite includes the NetworX Modeler^®, NetworX Modeler Analytics™ and NetworX Pricer applications. Together, these flexible solutions can help increase administrative efficiency, support compliance with regulatory standards and help health plans manage both the cost and quality of care.

About Health Care Incentives Improvement Institute

The Health Care Incentives Improvement Institute (HCI3) is a not-for-profit multi-stakeholder umbrella organization for Bridges to Excellence, Inc. and PROMETHEUS Payment, Inc. The mission of the organization is to create significant improvements in the quality and affordability of health care by developing and implementing programs that recognize and reward physicians, hospitals and other health care providers that deliver safe, timely, effective, efficient, equitable and patient-centered care. HCI3 offers a comprehensive package of solutions to employers, health plans and coalitions to improve the flawed incentives that currently permeate the U.S. healthcare system. PROMETHEUS Payment^® and ECR^® are registered trademarks of HCI3. www.HCI3.org

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’s solutions touch half of the U.S. insured population and reach more than 21,000 physician practices representing more than 75,000 practitioners. The company’s payer offerings include enterprise and component software, application hosting and management, business process outsourcing services and consulting that help transform and optimize operations. TriZetto’s provider offerings through Gateway EDI, a wholly owned subsidiary, include advanced tools and proactive services to monitor, catch and fix claims issues before they can impact a practice. TriZetto’s integrated payer-provider platform will enable the deployment of promising new models of post-reform healthcare. TriZetto is committed to the integration and convergence of technology systems that enable its vision of Integrated Healthcare Management, the coordination of benefits and healthcare to drive more value from every healthcare dollar spent. For more information, visit www.trizetto.com.

The TriZetto GroupLoren Finkelstein, 303-542-2460
[email protected]
or
Schwartz CommunicationsDavida Dinerman/Alex Parrella781-684-0770
[email protected]

Source: TriZetto