TriZetto’s End-to-End Solution Streamlines and Automates Benefits and Care Delivery for Health Insurance CO-OPs

DENVER, Dec. 12 -- TriZetto Group issued the following news release:

The TriZetto Group, Inc. (http://www.trizetto.com/), today announced the availability of an integrated software and services solution for Consumer Operated and Oriented Plans (http://cciio.cms.gov/programs/coop/index.html), or CO-Ops (http://cciio.cms.gov/programs/coop/index.html), offered at a monthly subscription price. The solution will provide the technology and staffing infrastructure that these nonprofit health plans need to administer benefits and care and enroll members by October 2013 for January 2014 effective dates. TriZetto's platform will give CO-OPs the flexibility to administer value-based benefits (http://www.trizetto.com/PayerSolutions/ValueBasedSolutions/) and reimbursement arrangements and the functionality to participate in state health insurance exchanges.

Under the Affordable Care Act, the federal government is subsidizing more than $3 billion in loans for consumer-focused CO-OPs to provide high-quality, low-cost, coordinated care beginning in 2014. Projected to serve as many as 12 million Americans through individual and small-group policies, most CO-OPs will operate on a local or state-wide basis and market themselves directly as well as through brokers and state exchanges.1

"TriZetto alone offers three advantages to CO-OPs," said Rob Scavo, TriZetto's regional accounts market president. "One, a reliable technology and staffing infrastructure (http://www.trizetto.com/PayerSolutions/) used by hundreds of healthcare payer organizations, including most of the country's nonprofit health plans. Two, a solution that manages population health (http://www.trizetto.com/HotTopics/PopulationHealthManagement/) transparently and engages consumers and providers in making the most informed decisions about care. Three, a nimble, flexible and functionally rich platform that deploys quickly, enables participation in state exchanges and supports innovative, emerging models of care delivery. With TriZetto's solution, CO-OPs can get a quick jump out of the starting blocks."

Tom Rekart, senior vice president of business management services at TriZetto, said the company's turnkey solution is ideal for CO-OPs, which must clear many hurdles to become operational. Loan applications require a feasibility study, actuarial analysis, business plan, budget and, possibly, application defense or resubmission. Additional challenges include staff recruitment, contract negotiations, public announcements, brand recognition and adverse selection. "With all of these considerations, it's reassuring to know that the health plan operations themselves are in good hands. It's one less concern for CO-OPs, and that's what TriZetto brings to the table," he said.

TriZetto's end-to-end technology and services solution for CO-OPs includes:

* Patented, integrated enterprise core administration and care management systems that streamline the administration of benefits and care delivery.

* Automated member acquisition among multiple marketplaces, through streamlined multi-channel enrollment.

* Application management services for accelerated implementations, high reliability, skillful maintenance, proactive processes and smooth upgrades.

* Business management services that deliver operational excellence by employing best practices and industry-experienced staff in performing the administrative functions of health plans, including member enrollment, premium billing, claims administration and customer service.

* Quantification and comparison of CO-OP performance with industry peers, using standardized metrics.

Additionally, through a strategic partnership with Health CO-OP Strategy Group, LLC (http://www.healthcoopstrategygroup.com/), TriZetto helps start-up CO-OPs mitigate the risks of delay and misaligned operations. "Together, we provide deep experience in defining specifications, identifying needs, developing integrated functions and enabling successful launch and execution," said Marcia Benshoof, founder and managing partner of Health CO-OP Strategy Group and a 30-year veteran in care-delivery systems, insurance financing and operations, business start-ups and turnarounds, and product development and distribution. "Health CO-OP Strategy Group has helped enable six insurance start-ups in the last three years and is a recognized authority on this new, highly specialized market."

TNS C-Santpan-Santpan 121213-4138751 71Santosh