NEWPORT BEACH, Calif. - July 7, 2010 - The TriZetto Group, Inc. today announced a partnership with professors who founded the value-based insurance design movement to develop chronic-condition templates as options for healthcare payer customers of TriZetto's Value-Based Benefits Solution.

Available to health plans that use TriZetto's enterprise platforms to administer benefits for more than 100 million Americans, TriZetto's solution is health benefit administration and incentive management software that gives 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. The initial set of templates will be automated through the Value-Based Benefits Solution and enable innovative benefit designs for health plan members who have diabetes, coronary artery disease, asthma, a smoking habit or depression, based on the professors' templates of proven best clinical practices.

Designed by professors A. Mark Fendrick, M.D., and Michael Chernew, Ph.D., of the Value-Based Insurance Design Institute (VBIDI), these five chronic-condition templates will launch this summer; additional templates will follow.

"Many healthcare technology solutions assume the clinical knowledge of users," said Dan Spirek, TriZetto's chief strategy and marketing officer and executive vice president, enterprise strategy and communications. "By packaging the clinical expertise of Drs. Fendrick and Chernew, TriZetto's Value-Based Benefits Solution is the first and only technology to combine fully automated value-based adjudication with proven best protocols for treating these chronic conditions. The likely advantages to healthcare payers are the accessibility of our solution, an accelerated time-to-benefit and hence ROI, and an increase in the percentage of effective member care and commensurate decrease in unwarranted member care."

"TriZetto will help us move value-based insurance design from the halls of academia to real-world application on a large scale," said Dr. Chernew, a professor in the department of healthcare policy at Harvard Medical School. "TriZetto's core administration systems can automate value-based insurance designs for health plans that touch more than a third of all Americans, and that's a big footprint for an approach to healthcare that we believe in passionately."

"Our partnership with TriZetto is a response to two elusive goals of U.S. healthcare reform – quality improvement and cost containment," noted Dr. Fendrick, a professor at the University of Michigan in the departments of internal medicine and health management and policy. "Most insured Americans pay the same amount for every doctor visit, diagnostic test and prescription drug within a formulary tier, regardless of the amount of health created. The basic premise of value-based insurance design is to remove patient barriers for essential, evidence-based services. With TriZetto, we'll be able to deploy value-based insurance design broadly, a viable response to both forces. Value-based designs offer one of the most effective and cost-efficient ways to increase the quality of care while beginning to bend the cost curve."

"Quite simply, professors Fendrick and Chernew literally wrote the book on value-based healthcare," said Jeff Rideout, TriZetto's senior vice president of care and cost management and chief medical officer. "They bring the highest level of clinical and economic expertise to the task of designing these much-needed algorithms that will customize claims adjudication for those with chronic conditions who drive more than 75 percent of healthcare costs."*

TriZetto's Value-Based Benefits Solution will use the templated algorithms for diabetics and pre-diabetics, for instance, to customize claims adjudication with no or low out-of-pocket costs for drugs, diabetes-monitoring office visits and related services known to help control diabetes.

Value-based insurance design individualizes benefits and claims adjudication to the specific clinical conditions of each high-risk member and rewards participation in health and wellness and appropriate condition management programs. Historically, these tasks have required a heavily manual, labor-intensive effort. TriZetto's Value-Based Benefits Solution automatically adjusts 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 -- helping improve member health and productivity and avert medical cost increases.

Dr. Fendrick's earliest work in the healthcare value movement came during the 1980s, when he conducted research with his mentor, Bernard Bloom, Ph.D., a pioneer in the subjects of health economics and healthcare reform. Dr. Fendrick collaborated with Dr. Chernew to write extensively during the 1990s when Pitney Bowes, Asheville, N.C., and others experimented with early efforts to remove barriers to effective care. A seminal paper followed in 2001 on the efficacy of customizing co-pays and coinsurance to encourage compliance, improve outcomes and mitigate subsequent, expensive and acute medical services. The two worked closely with congressional leaders to incorporate value-based insurance design guidance in this year's historic healthcare reform legislation and subsequent rule-making by the U.S. Department of Health & Human Services.

For more information about VBIDI, email information@vbidi.com.

About TriZetto

Founded in 1997, TriZetto is the leading privately held healthcare information technology company to the healthcare payer industry, with its technology touching half of the U.S. insured population. TriZetto's vision for the industry, Integrated Healthcare Management, is the optimized coordination of benefits and care for healthcare consumers to improve the value of every healthcare dollar spent. The company's offerings include enterprise and component software, hosting, outsourcing services and consulting that help payers implement and optimize their operations and minimize the risk of bringing to market new products that drive competitive differentiation.

Footnote:

* Centers for Disease Control and Prevention, www.cdc.gov/chronicdisease/resources/publications/AAG/chronic.htm, 2010.

Media Contacts:

Loren Finkelstein
The TriZetto Group
303-542-2460
loren.finkelstein@trizetto.com

Davida Dinerman
Schwartz Communications
781-684-0770
trizetto@schwartz-pr.com