TriZetto Enables BlueCross BlueShield of Tennessee to Implement Payment Bundling With Orthopedic Groups

TriZetto Enables BlueCross BlueShield of Tennessee to Implement Payment Bundling With Orthopedic Groups

<0> Schwartz MSL BostonDavida Dinerman/Nicole Solera, 781-684-0770orThe TriZetto GroupLoren Finkelstein, 303-542-2460 </0>

., announced today it has engaged with 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 and in Nashville, in Memphis and the .

Beginning in October, BlueCross, Tennessee’s largest health plan with 3 million members, will make single, 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.

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 .

TriZetto provides world-class information technology and service solutions that help payers and providers work more efficiently and 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 ; ; ; and compete to win in an emerging retail market. Payer solutions include , , and portal platforms, as well as , and . Provider solutions include real-time eligibility assurance and claims editing and that help providers get paid quickly and accurately. For more information, visit .

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