Capital BlueCross, TriZetto Partner to Improve Customer Health Outcomes Through Value-Based Benefits Solution

Capital BlueCross, TriZetto Partner to Improve Customer Health Outcomes Through Value-Based Benefits Solution

<0> Schwartz MSL BostonDavida Dinerman/Maggie Fairchild, 781-684-0770orTriZetto CorporationLoren Finkelstein, 303-542-2460 </0>

today announced that Harrisburg, Pa.-based has been receiving positive employer feedback about

Capital BlueCross’ value-based benefits structure allows employers to streamline the way they reward members who make good health choices through health and wellness activities or through actual medical services. Actions such as completing health risk assessments, biometric screenings and online coaching courses and obtaining appropriate care for chronic conditions can help improve the health status of employees. TriZetto’s innovative solution automates the administration of these activities, allowing employers and employees to easily track their progress in the program.

The capabilities of TriZetto’s solution enable health insurers such as Capital BlueCross to automate benefit designs that employers can customize based on the needs of their employee populations. These benefit designs promote and encourage healthy choices by members and help manage chronic conditions. For instance, a payer and its employer customer might want to reward diabetics for obtaining clinically appropriate services such as office check-ups, foot and eye exams and blood tests. TriZetto’s Value-Based Benefits Solution reduces the administrative burden of defining the compliance rules based on diagnosis and procedure information, identifying those diabetic members who should receive rewards and issuing the rewards for healthy choices.

Capital BlueCross group customers are pleased with how this innovative solution is working for their employees.

“At PSECU, our employees are our most valuable asset, and by keeping them healthy, they are then free to concentrate on our number one priority -- serving our members,” said Jean DeMichele, director, human resources, Pennsylvania State Employees Credit Union (PSECU). “But over the past few years it has become quite clear that education alone was not enough to encourage employees to make the type of tough behavior changes that were needed for them to live a healthier life. We needed more. By implementing a value-based benefits program, Capital BlueCross has made it easier for us to reach, engage and empower employees to take control of their health, particularly those with chronic conditions. By allowing us to incorporate incentives into the design of the benefit plan, our employees are now taking an active role in managing their condition, which will ultimately result in better health outcomes and positive lifestyle changes.”

“We are pleased but not surprised by the positive feedback to TriZetto’s Value-Based Benefits Solution from our group customers,” said Gary D. St. Hilaire, president and CEO of Capital BlueCross. “Employers understand how important it is for their employees to be engaged in their healthcare in a proactive way, especially when employees are managing a chronic condition. Good habits established by these employees have a positive impact not only on their health, but keep absenteeism in check. TriZetto’s solution allows a remarkably granular degree of flexibility and customization for employers, which enables us to zero in on population issues and promote the right services at the right time.”

St. Hilaire said that TriZetto’s Value-Based Benefits Solution was the next step by Capital BlueCross in its continuing commitment to innovative solutions that can improve member health.

More than a decade of case studies shows that by lowering co-pays or coinsurance for necessary, effective medical services and drugs that treat chronic conditions, value-based insurance designs can improve patient health and reduce more expensive, acute care. And with as much as three-quarters of the country’s nearly $3 trillion annual healthcare spend attributable to chronic-illness costs, the time is now for value-based benefits, according to Sal Gentile, TriZetto’s Blue Cross and Blue Shield market president.

“Capital BlueCross and other independent Blues organizations are to be commended for leading the way toward value-based healthcare in the United States,” he said. “They recognize two facts: One, chronic conditions and the aging population are combining to strain the healthcare system. And two, innovative value-based solutions are available today to help manage the associated costs and improve patient health.”

TriZetto’s value-based benefits solution helps @CapBlueCross improve customer #health and #wellness

In 2013, Capital BlueCross is celebrating 75 years of serving central Pennsylvania and Lehigh Valley residents and businesses as the region’s leading health insurer. Through its family of companies, Capital BlueCross brings innovative services and clinical solutions to the marketplace. Committed to delivering medical value to its communities, Capital BlueCross focuses on improving patient satisfaction, enhancing quality of care and reducing costs. The company continues to lead the change in the industry by meeting the evolving health needs of its customers, most recently by entering the retail market and building a first-of-its-kind health and wellness store called Capital Blue. Headquartered in Harrisburg, Pa., Capital BlueCross is an independent licensee of the Blue Cross and Blue Shield Association, employing more than 1,800 people. More information about Capital BlueCross can be found at .

TriZetto delivers world-class information solutions that enable healthcare organizations to work more efficiently and to deliver better health. Its solutions reach 200,000 care providers, streamline processes for more than 360 payers and touch over half the U.S. insured population. TriZetto solutions help increase , , and succeed in the retail healthcare market. Its solutions help and execute strategies for . TriZetto’s healthcare experience, innovative solutions and comprehensive services help simplify healthcare for everyone. For more information, visit .


1. Public information posting, Donald Berwick, M.D., CMS administrator, , June 21, 2011.


The Real Payback of Healthcare Analytics

With the unpredictability of healthcare today, organizations are sharpening their focus on analytics to make more data-informed decisions. Join us for a roundtable session in which thought leaders will discuss how they are maximizing their analytics investments.