The TriZetto Group announced the availability in early 2010 of the Value-Based Benefits Solution, health benefit administration and incentive management software that will give payer organizations the ability to customize benefits and other incentives for individual members based on their health status, chronic conditions and health and wellness activity.
Value-based benefit designs use financial incentives to encourage members to adopt healthier lifestyles and effectively manage chronic conditions by adhering to recognized healthcare guidelines.
"Employers, benefit consultants and the government are calling for value-based benefit designs to align consumers' incentives to improve health and reduce unnecessary healthcare costs," Jeff Rideout, M.D., chief medical officer and SVP of cost and care management at TriZetto, said in a release.
"With TriZetto's Value-Based Benefits Solution, healthcare payers will be able to meet this demand and differentiate themselves. By enabling this technology for the payers using TriZetto enterprise administration systems, we are poised to very rapidly make value-focused, incentive-based healthcare a reality for more than a third of the U.S. population."
Gail Knopf, vice president of enterprise strategy at TriZetto, stated: "The key to successful value-based benefits design is to truly individualize the benefits and claims adjudication to the specific clinical conditions of each high-risk member and to reward participation in health and wellness and appropriate condition management programs."
She added: "Until now, these tasks have required a heavily manual, labor-intensive effort. TriZetto's Value-Based Benefits Solution will automatically adjust co-pays or coinsurance on specific claims in real time during the plan year based on effective dates of qualifying events -- such as a diabetic health plan member completing a course to better understand his or her condition -- unlocking the potential of value-based benefits programs to improve member health and productivity and to stem medical cost increases."
Available on a licensed or hosted basis, TriZetto's solution will power applications that are used by a payer to administer comprehensive value-based benefits programs and by its members to view incentive benefit options and activity.
The Value-Based Benefits Solution will join a suite of TriZetto tools that includes the Treatment Cost NavigatorTM web application, which provides consumers with real-time calculation of member liability as opposed to estimates, and the Provider POS DirectTM web application, which gives providers real-time member liability and claims adjudication at the point of service.
Melanie Rodier has worked as a print and broadcast journalist for over 10 years, covering business and finance, general news, and film trade news. Prior to joining Wall Street & Technology in April 2007, Melanie lived in Paris, where she worked for the International Herald ... View Full Bio