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TriZetto Becomes Strategic Advisor, Technology Partner to BlueCross BlueShield of Tennessee
[July 30, 2012]

TriZetto Becomes Strategic Advisor, Technology Partner to BlueCross BlueShield of Tennessee

TMCnet Contributor
The TriZetto Group (News - Alert), a healthcare IT company, has become a strategic advisor and technology partner to BlueCross BlueShield of Tennessee. TriZetto will work together with four of the state's leading orthopedic practices to define and standardize best practices in medical care that health plan members should obtain before, during and after total knee and hip replacements.

BlueCross looks to implement a new concept called payment bundling, by which BlueCross will make single, bundled payments to the partnering providers for agreed-upon medical services provided during hip and knee replacements.
According to the agreement, TriZetto is providing BlueCross with a payment bundling software solution. The IT company will also help BlueCross' dialogue with medical practices. TriZetto's application will automate the processing of episode-of-care payments to BlueCross. 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 is Tennessee's largest health plan with three million members. Effective October 2012, BlueCross will begin to implement payment bundling, and BlueCross' officials are looking forward to launching the innovative system.
BlueCross provides solutions and services to drive administrative efficiency, improve the cost and quality of care, and increase payer and provider collaboration and connectivity.
"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," the VP added, "they are providing leading-edge technology that allows us to administer this program at scale and in an automated manner."
TriZetto's solution comprises 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.
Trizetto was recently in the news when its subsidiary, Gateway (News - Alert) EDI, acquired ClaimLogic, a medical claims and payment processing company. With the acquisition, TriZetto's combined healthcare provider and payer client base will broaden. TriZetto is currently offering revenue cycle management and EDI solutions to more than 180,000 care providers.

Edited by Braden Becker

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