The
TriZetto Group, Inc.,
announced today it has engaged with BlueCross BlueShield of Tennessee as a strategic advisor and technology
partner to collaborate with four of the state’s leading orthopedic practices to
define and standardize best practices in medical care that health plan members
should receive before, during and after total knee and hip replacements. The
participating practices are Vanderbilt Medical Group and Tennessee
Orthopaedic Alliance
in Nashville, Campbell Clinic in Memphis and the Knoxville
Orthopaedic Clinic
Beginning in October, BlueCross, Tennessee’s largest
health plan with 3 million members, will make single, bundled payments to the partnering providers for
agreed-upon medical services provided during hip and knee replacements,
including pre-operative care, surgery, post-operative care and rehabilitation.
This new approach to physician and hospital reimbursement is called payment
bundling, and BlueCross’ Tom Lundquist, M.D., is looking forward to launching
the innovative system.
“The process is
highly collaborative,” said Lundquist, vice president of performance
measurement and improvement of healthcare services for BlueCross. “TriZetto has
a seat at the table with the clinicians and with us. They provide valuable
information, analysis and documentation that frame constructive dialogue to
arrive at bundle definitions and quality metrics. As a third party, TriZetto
helps move the medical practices and BlueCross toward consensus on best
practices that can help ensure optimal patient care and outcomes, as well as
cost efficiencies. Additionally, they are providing leading-edge technology
that allows us to administer this program at scale and in an automated manner.”
“BlueCross and
these four medical practices are to be commended for being pacesetters in
collaborating on payment bundling,” said Jeff Rideout, M.D., TriZetto’s senior
vice president, cost and care management, and chief medical officer. “The
promise of this form of value-based reimbursement cannot be overstated. It can
rein in rising healthcare costs by reducing the unwarranted variations in care
prevalent in today’s fee-for-service model. Further, it can improve the quality
of care. A single group payment encourages caregivers to function as one team,
share information, coordinate care and work without walls to optimize the
patient’s health outcomes.”
In addition to
facilitating the health plan’s dialogue with medical practices, TriZetto is
providing BlueCross with a payment bundling software solution. The
patent-pending application will automate the processing of episode-of-care
payments to BlueCross. Payer clients such as BlueCross can create their own
bundle designs into the software. In addition, TriZetto’s solution includes
pre-configured common episodes of care that have been defined by national
entities, including the Centers for Medicare and Medicaid Services and
Integrated Healthcare Alliance of California. The solution pre-integrates with
TriZetto’s core administration and network management systems, and is also
designed to work with systems from other vendors.
BlueCross
anticipates a dozen or more medical practices will participate in the health
plan’s payment-bundling program by the first half of 2013 and plans to broaden
the program to additional episodes of care following evaluation of the initial
projects.
About
BlueCross
BlueCross
BlueShield of Tennessee's mission is to provide its customers and communities
with peace of mind through affordable solutions for health and healing, life
and living. Founded in 1945, the Chattanooga-based company is focused on reinventing
the health plan for its 3 million members in Tennessee and across the country.
Through its integrated health management approach, BlueCross provides
patient-centric products and services that drive health improvement and
positively impact health care quality and value. BlueCross BlueShield of
Tennessee Inc. is an independent licensee of the BlueCross BlueShield
Association. For more information, visit the company's website at www.bcbst.com.
About TriZetto
TriZetto provides world-class
information technology and service solutions that help payers and providers
work more efficiently and collaborate to
deliver better health. TriZetto solutions touch over half the U.S. insured
population and reach more than 100,000 care providers. TriZetto helps
healthcare organizations address compliance; enhance administrative efficiency; improve the cost, quality and delivery of care; and compete to win in an emerging retail market.
Payer solutions include benefits administration, care management, network management and portal platforms, as well as consulting, application management and business management services. Provider
solutions include real-time eligibility assurance and claims editing and revenue cycle management technology and services that help providers get paid quickly and
accurately. For more information, visit www.trizetto.com.
Media Contacts:
Davida Dinerman/Nicole Solera
Schwartz MSL Boston
781-684-0770
trizetto@schwartzmsl.com
Loren Finkelstein
The TriZetto Group
303-542-2460
loren.finkelstein@trizetto.com