Trizetto Group has introduced a software solution that enables healthcare payers to customize benefits and provide incentives for individual members based on their health status, chronic conditions, and health and wellness activities.
The Greenwood Village, Colo.-based health IT company said Wednesday that its new Value-Based Benefits Solution works with Trizetto's Facets and QNXT, two value-based insurance design platforms that help health insurance companies automate enrollment, as well as provide premium billing, claims adjudication, and other administrative functions. These tools are used by 137 health plans to provide coverage to 107 million Americans.
"The Value-Based Benefits Solution is another important component of Trizetto's broad strategy to create solutions to help better align information and incentives across members, providers, and employers," Dan Spirek, Trizetto's executive VP and chief strategy and marketing officer, said in a statement.
Value-based insurance products are used to identify and reduce patients' out-of-pocket costs for proven, effective pharmacy and medical services for chronically ill patients. By doing this, patients with chronic diseases are better able to afford doctor visits, medicines, and other health and wellness activities, which could prevent a further decline in their health.
"Our Value-Based Benefits Solution targets patients with select clinical diagnoses and lowers co-payments or coinsurance for specific, high-value medical and pharmacy services as consumers take positive action, not at some fixed point in time such as open enrollment," Gail Knopf, VP of enterprise strategy at Trizetto, said in a statement. If desired, enhanced benefits take effect only after the patient has completed online education on his or her condition, or has spoken with a health coach or disease manager,"
Knopf also said Trizetto's product automates workflow processes -- individualized adjudication of medical claims -- that have historically been very labor-intensive. "A variety of incentives can be offered to engage the patient at each step, from health assessment through the care process," Knopf added.
Company executives said the Value-Based Benefits Solution includes a web application that gives healthcare payers the ability to configure and manage incentive programs, manage program members, and log compliance. The solution can also help payers process claims adjudication of member-specific, value-based benefits in Trizetto's Facets and QNXT enterprise systems, and communicate with third-party health management vendors.
For subscribers to health insurance plans, the Value-Based Benefits Solution provides the online ability to view incentive program details and available rewards and to enroll in applicable programs. Subscribers can also link to health management programs that recommend ways to help them manage their health and offers rewards for their participation.