August 11, 2010

Greenwood Village, Colo.-based vendor TriZetto has made available the Value-Based Benefits Solution health benefits administration and incentive management software.

The platform leverages the company’s Facets and QNXT enterprise administration systems to customize benefits and provide incentives for individual members based on their health status, chronic conditions, and health and wellness activity, the company says in a statement.

It also includes a Web application that gives healthcare payers the ability to configure and manage incentive programs, manage members in programs and log compliance, enable claims adjudication of member-specific value-based benefits in Facets and QNXT and communicate with third-party health and wellness and reward vendors, the company adds.

“TriZetto’s solution can certainly handle basic value-based design requirements, but it also can provide value-based insurance designs in advanced forms, including multiple incentives that are member- and condition-specific,” Gail Knopf, vice president of enterprise strategy at TriZetto, says in a statement. “Our Value-Based Benefits Solution targets patients with select clinical diagnoses and lowers co-payments or coinsurance for specific, high-value medical and pharmacy services as consumers take positive action, not at some fixed point in time such as open enrollment. TriZetto’s product automates what historically has been a very labor-intensive, individualized adjudication of medical claims."

The member Web portal lets policyholders view incentive program details and available rewards, as well as enroll in applicable programs. It also contains links to program and reward vendors.

Through a partnership with Hallmark Business Connections, a subsidiary of Hallmark Cards, TriZetto’s Value-Based Benefits Solution automates online gift card selection from hundreds of retailers, the company says. Additionally, TriZetto’s Value-Based Benefits Solution is available with optional templates of benefit designs for those chronic conditions which drive the greatest claim costs. The initial benefit design templates include diabetes, coronary artery disease, asthma, smoking cessation and depression. The templates are pre-configured in the Value-Based Benefits Solution, Facets and QNXT.

Saint Mary's Health Plans licensed TriZetto's claims program earlier this month. The vendor also has recently launched personal health record and benefits platforms.

Nathan Golia is senior editor of Insurance & Technology. He joined the publication in 2010 as associate editor and covers all aspects of the nexus between insurance and information technology, including mobility, ...