TriZetto
Driving Efficiency in a Post Healthcare Reform World

As the healthcare industry continues to evolve, the roles of payers and providers are converging at a rapid pace. Healthcare reform has driven a significant amount of change in the industry and as a result, the traditional technology solutions of yesterday no longer meet the growing needs of this dynamic and evolving market. Progressive vendors such as TriZetto—a company that delivers innovative healthcare information technology solutions to drive administrative efficiency, improve the cost and quality of care, and provide clients a competitive advantage in the volatile healthcare market, are addressing the needs of healthcare organizations along with partners such as Microsoft. “Microsoft provides robust and comprehensive solutions across multiple verticals. Their solutions provide more value to customers, than many take advantage of. In addition, many customers can improve on how to maximize the value of Microsoft solutions resulting in improved business efficiencies,” says Cindy Schumacher, Chief Information Officer, TriZetto Corporation.

Schumacher feels that in an era where there has been a significant amount of change—mainly due to multiple forces including the Affordable Care Act (ACA), payers and providers are compelled to focus on controlling costs, increasing administrative efficiency and collaborating more effectively to drive value-based care. This is where TriZetto supports their customers in transforming, enhancing, and optimizing their businesses. The company provides payers with solutions that leverage technology from Microsoft to manage benefits and care for members, while complying with the ACA, and in addition helps providers collaborate with payers to streamline healthcare transactions.

TriZetto provides end-to-end solutions that drive unparalleled administrative efficiency across business processes, while enabling new models of care. Partners such as Microsoft help TriZetto develop and enhance their solutions to support more than 350 payer customers representing well over 180 million insured Americans–or more than 50 percent of the U.S. insured population. In addition, the company serves more than 245,000 provider customers and more than 400 practice management/ electronic medical systems integrations.

TriZetto’s solutions will continue to support clients as the changing healthcare landscape continues to evolve with payment reform, payer/provider collaboration and the shift to consumerism

“TriZetto continues to develop new functionality to support clients as the changing healthcare landscape evolves with payment reform (the move towards fee-for-value vs. fee-for-service), payer/ provider collaboration (the converging roles of payers and providers and the necessity to breakdown information silos) and the shift to consumerism (whether buying insurance or accessing care),” says Schumacher.

The following examples demonstrate ways in which TriZetto’s solutions support their client in transforming, enhancing, and optimizing their businesses. In the past year, TriZetto has helped 53 of its clients, across 30 states, to participate in the newly formed health insurance exchange marketplaces that now serve the individual market. As payers move towards new fee-for-value models with their providers, TriZetto gives clients capabilities for payment-bundling to reimburse providers for entire episodes of care. In addition, value-based benefit capabilities help payers align consumer incentives with the care they need. TriZetto’s core administration solutions automate many of the complex processes around the administration of benefits and claims to reduce administrative costs and leave time for clients to focus on other priorities.

Going forward, the company is focused on enhancing and developing solutions that further address the rise of individual lines of business including government programs like Medicare Advantage and Medicaid. It also will continue to support improving the administrative efficiency of core administration for health plans, while lowering the total cost-ofownership through technology platform advancement.