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Trizetto Adding Disease Management Algorithms For Insurers With “Value Based Benefit Solutions” To Manage Program Me

Posted Aug 12 2010 1:52pm

In short we have more algorithms and transaction fees being added to pay for additional intelligence with software.  Patients will essentially be guided to remain in network when identified as chronic care members, and gee any more are we not all in that category with something diagnosed? I think chronic are is being a bit over image used these days perhaps not so much in the clinical end but in the analytic and payment end of things as one more identifiable identify that needs additional algorithmic studies to bottom line every expense paid out on one patient.  The company CEO came from Cerner and Trizetto is owned by a private equity firm in the UK, APAX so all profits go abroad to that group of investors. 

Not too long ago I questioned some of the marketing information they released and wish I had a group of consumers that were as smart as this survey said, read up and see for yourself. 

Trizetto Group (Wholly Owned Subsidiary of Apax Partners London Based Private Equity Firm) Says Their Study Indicates the US Healthcare System is Ready to Adopt Value Based Insurance Designs – Marketing At Its Best


The company has 3rd party contracts and works with one senior group in the Los Angeles area called CareMore to supply algorithmic business intelligence and claim processing.  Much of the focus of the company as you can see from the image above is “power to the employer” with their targeted audiences of payers. 

CareMore Live On TriZetto's Clinical CareAdvance System Algorithms - Healthcare Business Intelligence

Trizetto works with many of the algorithmic formulas created by Ingenix (a wholly owned subsidiary of United Healthcare) for their reporting, “scoring” and algorithmic formulas to verify enrollment, pay claims and so on.   As you can see United Healthcare is in here for a cut of the profits with their subsidiary and with share holder liabilities taking the front run and we heard about the record profits made.

The question is here are we creating more VALUE or just more analytic algorithms that really help with healthcare and expediting claims?  Insurers buy and pay for such services and we get passed down in the premiums we pay. The more complicated you keep the system, the more it leads to additional analytics that we all pay for and some of these programs programmatically deny our claims too as many insurers outsource quite a bit today too.  BD

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.

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.

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