The TriZetto Group Inc. announced this week a partnership with professors who founded the value-based insurance design movement to develop chronic-condition templates as options for healthcare payer customers of TriZetto's Value-Based Benefits Solution.
The initial set of templates will be automated through the Value-Based Benefits Solution and enable innovative benefit designs for health plan members who have diabetes, coronary artery disease, asthma, a smoking habit or depression, based on the professors' templates of proven best clinical practices.
Designed by professors A. Mark Fendrick, M.D., and Michael Chernew, Ph.D., of the Value-Based Insurance Design Institute (VBIDI), these five chronic-condition templates will launch this summer; additional templates will follow.
"TriZetto will help us move value-based insurance design from the halls of academia to real-world application on a large scale," said Chernew, a professor in the department of healthcare policy at Harvard Medical School.
"TriZetto's core administration systems can automate value-based insurance designs for health plans that touch more than a third of all Americans, and that's a big footprint for an approach to healthcare that we believe in passionately."
TriZetto's Value-Based Benefits Solution will use the templated algorithms for diabetics and pre-diabetics, for instance, to customize claims adjudication with no or low out-of-pocket costs for drugs, diabetes-monitoring office visits and related services known to help control diabetes.
"Many healthcare technology solutions assume the clinical knowledge of users," said Dan Spirek, TriZetto's chief strategy and marketing officer and executive vice president, enterprise strategy and communications. "By packaging the clinical expertise of Fendrick and Chernew, TriZetto's Value-Based Benefits Solution the likely advantages to healthcare payers are the accessibility of our solution, an accelerated time-to-benefit and hence ROI, and an increase in the percentage of effective member care and commensurate decrease in unwarranted member care."
Value-based insurance design individualizes benefits and claims adjudication to the specific clinical conditions of each high-risk member, and rewards participation in health and wellness and appropriate condition management programs. Historically, these tasks have been labor-intensive. TriZetto's Value-Based Benefits Solution automatically adjusts co-pays or coinsurance on specific claims in real time during the plan year based on effective dates of qualifying events - such as a diabetic health plan member completing a course to better understand his or her condition - helping improve member health and productivity and avert medical cost increases.
"Our partnership with TriZetto is a response to two elusive goals of U.S. healthcare reform - quality improvement and cost containment," said Fendrick, a professor at the University of Michigan in the departments of internal medicine and health management and policy. "Most insured Americans pay the same amount for every doctor visit, diagnostic test and prescription drug within a formulary tier, regardless of the amount of health created. The basic premise of value-based insurance design is to remove patient barriers for essential, evidence-based services."