TriZetto and its Payer Solutions-III

TriZetto's Payer Solutions cover the following areas:

1. Core Administration

2. Care Management

3. Health TranZform

4. Network Management

5. Value-Based Solutions

6. Portal Technology Solutions

7. Optimization Tools

So far we have discussed about Core Administration. Now we will throw some on Care Management,  Health TranZform and Network Management .

2. Care Management Under Payer Solutions

TriZetto's Care Management tool is CareAdvance Enterprise solution. It helps transform siloed care management into an advanced, member-focused, integrated program. Successful care management programs reduce costs, personalize interventions, enhance outcomes and improve the quality of care.  TriZetto’s CareAdvance Enterprise solutions can help healthcare payers meet the new challenges of care management. CareAdvance Enterprise comprises three solutions, including: TriZetto Clinical CareAdvance bringing automation to a wide range of clinical care management functions and TriZetto Personal CareAdvance, providing members with Web-enabled access to care information.

i. Clinical CareAdvance

Using configurable business rules, Clinical CareAdvance helps insurance organizations reduce cost and improve care management by providing personalized information and services and streamlining utilization management workflows. The solution also provides access to evidence-based clinical guidelines, improves data management, and provides tools that deliver significant benefits in disease management, case management solutions, and utilization management.

ii. Personal CareAdvance

The TriZetto Personal CareAdvance application gives healthcare payers a secure, web-based solution. It helps their members to manage their own health more effectively. Drawing from the Healthwise Knowledgebase, the Personal CareAdvance application proactively pushes appropriate information to the right person at the right time. The members get a 360-degree view of their personal health summary. The solution helps them:

Ø  To collect and record personal health information and complete and submit health risk assessments.

Ø  To track clinical metrics, receive reports on their health progress and receive alerts when their health status changes.

Ø  To interact with care managers, providers and family members.

In addition to providing a core health record and messaging platform, the Personal CareAdvance application delivers a wide array of integrated member health tools, including health diaries, medication and condition lists, a personal health summary, and more.

3. Health TranZform under Payer Solutions

Health TranZform is a new suite of solutions that enables collaboration across healthcare and breaks down data silos.The engine behind TranZform that enables healthcare stakeholders to easily interact across the care continuum is the TranZform Platform. The TranZform Platform enables cross-system communications, data reconciliation and interoperability to support healthcare transactions and decision-making.

i) EngageConsumer

EngageConsumer solution helps healthcare payers offer a competitive digital experience to attract new customers, retain current business, and compete in exchange markets. Mobile-enabled, portal-based, and flexible, the EngageConsumer solution provides functionality to help consumers easily shop for benefits, get quotes, compare plans, and enroll in a health plan through public or private exchanges.

4. Network Management under Payer Solutions

i) NetworX Modeler

ii)NetworX Pricer

iii)NetworX Payment Bundling Administration

i) NetworX Modeler

NetworX Modeler is a sophisticated contract modeling application that enables healthcare payers' contract management teams to perform in-depth, high-precision analyses of all provider contract scenarios. Healthcare payers can download actual historical claims data and run different scenarios at the contract-term level— no matter how complex the rates and terms. With this information, they can quickly forecast results, negotiate the best terms and improve the financial outcomes of every contract. All this can be done without the need of support from IT or other departments.

ii) NetworX Pricer

NetworX Priceris a Java-based application that integrates with TriZetto and non-TriZetto core claims administration systems. The NetworX Pricer application automates claims pricing for even the most complex provider contracts. With this patented and patent-

pending application, Healthcare payers can manage more sophisticated contracts easily, process claims faster, minimize inconsistencies  and reduce errors

iii) NetworX Payment Bundling Administration

This is how NetworX Payment Bundling Administration works:

Ø  Integrates tightly with payers' claims processing system, whether that’s a TriZetto solution or third-party application.

Ø  Evaluates each fee-for-service claim made during the adjudication process to determine whether the claim belongs to an identified episode-of-care bundle.

Ø  Creates episodes of care prospectively, in real time.

Ø  Bundles related claims together from multiple clinicians working on a specific episode.

Ø  Re-prices claims to conform to the agreed total payment for each episode of care.