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TriZetto Group, Owned by Apax Partners-London Based Private Equity Firm, Rolls Out Payer Based PHR

Posted Feb 24 2010 12:15pm

Earlier this year, TriZetto was purchased by Apax Partners, a London based private equity firm for 1.4 billion so somebody wants a return on their investment somewhere along this line.  They also have a large agreement in the Netherlands for processing claims and other financial interests.  Back a few months ago the initial announcement was made about the PHR.  image

TriZetto Announces New Feature for Personal Health Records – Auto Populated for the Consumer But Payer Access for Eligibility Questions from Providers

The one good side is the populating of payer information as well as information from physicians which is available for patients.  I think what I would do is take the information and send it on over to my HealthVault account as that is where I would feel most comfortable adding and storing my information and share with my doctor in that fashion. 

Adding payer information and populating HealthVault still keeps me in control and I have no idea where TriZetto is storing the information and who else could have access and I looked at some of the partners here like Ingenix and they are some of the same folks that sell our medication records for profit too, so one has to look at the entire picture rather than just making investors happy, my healthcare concerns come first over investor profits in my book.

Quality Care Solutions aligned themselves with Ingenix back in January 2006 to integrate the QNXT software system with the Ingenix Payor products and systems, in other words the algorithms that analyze and score claims.  It sounds like more money and profits for that division of United Healthcare.   

This type of information is good to be aware of when disputing a medical claim that has been denied or otherwise disputed as many insurance companies are using such technologies and services to help them run the algorithms for profitability and business intelligence in their operation, so your dispute could be based on analytics from a 3rd party as such and sometimes when algorithms are run looking for potential fraud, you end up with some false positives in there as well. 

We have the same situation going on with Wall Street too, ask any broker, it’s all about the algorithms that create profits where they didn’t exist before with contracts and transactional services.  BD 

Goldman Stolen Code – Has Algorithmic Fraud Become A Business Model in HealthCare Too?

NEWPORT BEACH, Calif.--( BUSINESS WIRE )--The TriZetto Group, Inc. today announced the general availability of its payer-based Personal Health Record (PHR). Now offered to consumers and their physicians through health plans, TriZetto’s PHR is the nation’s first electronic record available to as much as a third or more of all Americans with private health insurance.

“While there’s much discussion on Capitol Hill and in the healthcare community about the promise of electronic health records (EHRs) and electronic medical records (EMRs), these provider-based tools are years away from broad adoption”

TriZetto’s PHR downloads to the doctor when office staff requests confirmation of a member’s eligibility. It is accessible online to the member, is designed for easy portability, so it follows the consumer when he or she changes health plans.

Unlike an EHR or EMR, which captures a patient’s medical record at just one hospital or medical practice, TriZetto’s PHR captures the patient’s record of care from all the providers that file claims. It therefore provides each treating clinician with a more complete view of the patient’s health history, enhancing the coordination of care.

TriZetto’s PHR advances TriZetto’s Integrated Healthcare Management (IHM) strategy by tapping the healthcare information in payer organizations to provide physicians and consumers with the right information at the right time so they can make the most informed decisions about medical care. TriZetto defines IHM as the systematic application of processes, shared information and aligned incentives to optimize the coordination of benefits and care for the healthcare consumer

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