GREENWOOD VILLAGE, Colo.- June 23, 2011 –With the passage of the healthcare reform law, healthcare payer organizations must address four challenges to succeed in today’s changing and evolving industry, said Dan Spirek, executive vice president and chief strategy and marketing officer of The TriZetto Group, Inc., in remarks during last week’s Institute 2011 in San Francisco. The Institute is an annual gathering of health insurers and vendor companies staged by America’s Health Insurance Plans.

“In listening to our broad customer base, we believe the four challenges for payers are comply with reform, increase administrative efficiency, improve cost and quality of care and compete to win,” Spirek said. “To comply with reform, health plans need a healthcare IT partner that can provide flexible and scalable enterprise-wide administrative solutions, maximize efficiencies to meet new medical-loss-ratio requirements and help them meet the HIPAA 5010 and ICD-10 mandates and even exploit them for strategic advantage.”

To increase administrative efficiency, payers need enterprise systems that further automate tasks and reduce manual configurations, as well as application hosting and business-process outsourcing services. Spirek said that the right healthcare IT partner can help payers improve the cost and quality of care through innovative value-based strategies that support emerging care delivery models such as patient-centered medical homes and accountable care organizations.

“Technology available today enables value-based insurance design, which incents members to use proven, high-value healthcare services and reimburses providers for the coordinated, quality delivery of care,” said Spirek. “New solutions also enable clinical analytics, which greatly enable the stratification and identification of members by health risk and support the participation of members in programs that can help improve their health.”

To compete to win, he said, health plans should choose a healthcare IT vendor that can provide technology solutions that help achieve competitive differentiation, attract and retain customers and engage constituents. The solutions should enhance payers’ connectivity and collaboration with providers to reduce the paperwork, phone calls and re-work that prove an administrative burden for all constituents.

Spirek’s keynote presentation about the four challenges provided fitting context for TriZetto’s exhibit at the conference. The exhibit featured advanced software and service solutions that help payer organizations drive efficiency, improve the quality of member care, reduce costs and compete in new lines of business. Solution demonstrations included TriZetto’s NetworX Payment Bundling Administration™ application, which automates the processing of episode-of-care payments to providers; TriZetto’s Facets™ and QNXT™ enterprise core administration systems; TriZetto’s CareAdvance Enterprise® suite of care management applications, including CareAdvance Provider™; and TriZetto’s Advantage 10 Payment AnalytiX™ solution, which helps payers maintain financial neutrality between ICD-9 and ICD-10 codes to minimize migration risk. A video loop shared the stories of healthcare payer customers who explained how TriZetto’s solutions have helped their organizations uncover new efficiencies and greater productivity in meeting new challenges.

During the conference, TriZetto’s executive reception at the renowned San Francisco Museum of Modern Art served as a creative backdrop for health plan leaders to exchange ideas, concerns and reflections on challenges and emerging opportunities in U.S. healthcare.

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.

 

Media Contacts:

The TriZetto Group
Loren Finkelstein
303-542-2460
loren.finkelstein@trizetto.com

Schwartz Communications
Davida Dinerman
781-684-0770
trizetto@schwartzcomm.com