“As much as a third of what we spend on healthcare in America does nothing to improve our health,” said Dan Spirek, TriZetto’s co-founder, chief strategy and marketing officer and executive vice president of enterprise strategy and communications, during a WHCC keynote session. “Money wasted on unwarranted variations in care could be saved through better alignment of information and incentives using VBID mechanisms. Value-based strategies use financial incentives to encourage the most appropriate care by physicians and ongoing compliance by patients, and integrated software solutions available today make possible broad adoption of these strategies by helping payers automate and administer complex, customized value-based models.”

He stressed, as well, the importance of greater payer-provider connectivity and collaboration.

“Improved connectivity and collaboration would enable payers and providers to deliver more value for every healthcare dollar spent,” Spirek said. “For instance, some $150 billion is spent annually to confirm the eligibility and process the claims of patients. We likely can save tens of billions of dollars by integrating the claims systems of insurers with the practice management systems of physician groups, which potentially would eliminate a significant volume of re-work, phone calls, paper-based claims and other costly inefficiencies. With emerging technology, this new reality is right around the corner.”

Katie Neben, TriZetto’s director of VBID product management, presented “three tenets of effective value-based benefit design” in a meeting with healthcare payer organizations and employers sponsored by the company.

“Member engagement, design effectiveness and operational cost-efficiency are key components that payers and employers should consider to help ensure success,” said Neben. “Program participation is where the rubber meets the road, and participation rises when you reach members with messages and through media that resonate with them.”

For an effective program design, an organization should analyze its population “to identify conditions ripe for patient action to improve health status and lower medical costs,” she said. “It could be diabetes, heart disease or a combination of chronic conditions. Then, design programs to address these conditions, with interventions in which members can improve their health, earn rewards that are meaningful to them and, as a result, likely reduce the associated medical claim costs.”

To minimize administrative costs, said Neben, an organization can “design operational flows to maximize automation and integration with existing systems and automate communication between health plan, program vendor, employer and member.”

She also said organizations, to the greatest extent possible, should automate the identification of members who have completed program requirements (i.e., program compliance), as well as the issuance of rewards for those members. Neben further suggested that member rewards – enhanced benefits, gift cards, HRA or HSA account contributions or employee premium-contribution reductions – be tied to specific member achievements.

TriZetto last year debuted its Value-Based Benefits Solution, health benefits administration and incentive management software that enables healthcare payers to customize benefits and provide incentives for individual members based on their health status, chronic conditions, and health and wellness activity. The company’s Value-Based Benefits Solution automates the administration of value-based insurance designs that leverage enterprise administration systems used by more than 130 health plans to provide coverage for more than a third of Americans. TriZetto will introduce a value-based provider-payment solution this year.

TriZetto’s Spirek and Neben are available for reporter interviews through Schwartz Communications at trizetto@schwartzcomm.com or 781-684-0770.

About TriZetto

TriZetto provides world-class healthcare IT software and service solutions, including patented and patent-pending innovations, that drive administrative efficiency, improve the cost and quality of care, and increase payer and provider collaboration and connectivity. TriZetto’s solutions touch half of the U.S. insured population and reach more than 21,000 physician practices representing more than 75,000 practitioners. The company’s payer offerings include enterprise and component software, application hosting and management, business process outsourcing services and consulting that help transform and optimize operations. TriZetto’s provider offerings through Gateway EDI, a wholly owned subsidiary, include advanced tools and proactive services to monitor, catch and fix claims issues before they can impact a practice. TriZetto’s integrated payer-provider platform will enable the deployment of promising new models of post-reform healthcare. TriZetto is committed to the integration and convergence of technology systems that enable its vision of Integrated Healthcare Management, the coordination of benefits and healthcare to drive more value from every healthcare dollar spent. For more information, visit www.trizetto.com.