Third-party administrator (TPA) clients of The TriZetto Group, Inc., today lauded the company’s “flexible solutions,” noting that they have helped their businesses grow and pursue new opportunities.
“Our company once provided only self-funded benefits administration services for employer groups,” recalled Larry Dust, chief executive officer of Key Benefit Administrators (KBA), an Indianapolis-based TPA with some 200,000 members. “Today, fewer than half our members are served by self-funded health plans. TriZetto’s flexible QicLinkTM enterprise core administration system has accommodated the evolution of our business model.”
KBA, a longstanding TriZetto client, provides claims administration services for a dozen healthcare payers that offer fully insured plans, in addition to supporting the traditional self-funded plan model. Many of these fully insured plans provide limited medical benefits, accident, cancer and other supplemental coverage.
“These plan designs aren’t cookie-cutter; they present special challenges and could require lots of manual touches,” Dust said. “But not with TriZetto’s benefits administration solution. Its stable, scalable platform streamlines the administration of traditional and alternative plan designs.”
In 2002, Dust developed the American Health Data Institute (AHDI), a population health management (PHM) solution for the benefits administrator market. The nation’s largest database of a consistently applied PHM methodology, AHDI has helped more than 98 percent of its employer customers keep the cost of care below the rate of inflation in medical trend.
The solution is available to TriZetto’s TPA clients through the company’s Premier Partnership ProgramTM, a suite of optimally priced vendor tools and services pre-integrated with TriZetto’s core administration platform.
Dust believes TPAs that use TriZetto’s integrated benefits administration and PHM solution are poised for success under healthcare reform. Steve Rasnick, president of TriZetto client Self Insured Plans LLC, couldn’t agree more and founded Accountable Care Administration LLC to pursue an especially promising, post-reform opportunity.
“Accountable care organizations (ACOs) present a great opportunity for TPAs,” said Rasnick. “Those ACOs which meet quality-of-care targets and save money for their clients will retain a portion of the savings. That’s a significant incentive for participating providers and for self-funded employer groups, which pay only for claims they actually incur. Uniquely, TriZetto has the integrated solution to help improve population health, control claim costs and administer self-funded benefits under the ACO model of care delivery in the Medicare, Medicaid and commercial markets.”
Rasnick also sees an opportunity for benefit administrators in health-benefit exchanges and in their precursor, co-ops. Co-ops, he explained, are “mini-exchanges” for which the federal government has set aside some $3 billion in funding. About 30 entities so far have filed to create co-ops.
Rasnick said TriZetto’s enterprise administration solution is flexible enough to support TPAs in serving both the co-op and exchange markets. “I’ll put it this way: Over the years, I founded 19 TPAs serving as many as a million lives and paying billions in claims, and I licensed TriZetto’s solution for them all. I never had to walk away from a prospect because TriZetto’s platform was unable to support our administration of their plan.”
Naples, Fla.-based Self Insured Plans has found great value in TriZetto’s business management services, as well. For five years the company has used TriZetto’s trained examiners and other expert staff to administer claims and customer service. “Ten years ago, a TPA’s value prop was in how well and fast it paid claims,” said Rasnick. “Today, our value is in population health management and cost control through risk management. TriZetto’s enabled us to redirect our resources to these priorities and points of differentiation without compromising high service levels.”
”While we’re delighted to work with our many new TPA clients, TriZetto’s also very proud to have served a number of benefit administrators for decades,” said Rob Scavo, regional market president at TriZetto. “Larry’s and Steve’s organizations have been valued partners for more than a quarter century. Over the years, they’ve been extremely nimble in positioning and repositioning for success, and through their drive, innovation and success, they’ve made us better, as well.”
TriZetto serves 107 benefit administrators. These TPAs administer the underlying self-funded medical and dental claims of nearly 6 million member lives and often provide additional offerings, including reinsurance, voluntary benefits, COBRA, short- and long-term disability, fully insured products, consumer-driven plans, long-term care and Medicare supplement. TriZetto’s Premier Partnership Program is an exclusive offering that leverages the company's industry-leading QicLink claims administration platform, and its largest single source of self-funded employer membership, to generate attractive pricing, packaging and QicLink system integration from key businesses. These businesses provide TriZetto’s TPA clients with information systems and services - such as AHDI and a national proprietary network - that can improve efficiency, competitive advantage and management of plan risk.
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 achieve 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.
The TriZetto Group
Schwartz MSL Boston
Davida Dinerman/Nicole Solera