TriZetto's payer software signals the arrival of payment bundling

Bundled payments are coming. One of the clearest signs is TriZetto's launch of an automated bundling solution for health plans, employer consortia, and third party administrators. What this means is that private payers -- like Medicare -- are planning to start bundling at a much more comprehensive level than case rates for individual procedures.

Medicare has been testing the bundling of acute and post-acute care for 18 months under its Acute Care Episode (ACE) Demonstration Program. That pilot encompasses just five sites. But a bigger bundling pilot, to involve 200 to 300 sites, will reportedly begin in January 2013.

Meanwhile, the commercial payers aren't letting any grass grow under their feet. Some are already trying to administer bundling with manual processes, according to Jeff Rideout, senior vice president and chief medical office of TriZetto, one of the largest software suppliers to health plans. But that's inefficient, he says, so TriZetto's NetworX Payment Bundling Administration application should meet a need in the marketplace.

How large a need is unclear at this point. But the new TriZetto solution is ambitious: It automates the bundled payment of 10 common episodes of care, including heart bypass surgery, knee replacement, hip replacement, and certain outpatient procedures.

In addition, TriZetto has licensed a package of bundled payment software to the Health Care Incentives Improvement Institute (HCI3), which is piloting the Prometheus Payment bundling approach in a number of healthcare systems. Although its methodology is different from Medicare's ACE program, Prometheus is, in effect, the private-sector version of CMS' bundling demonstration.

TriZetto is licensing to HCI3 more than 20 additional pre-configured payment bundles for heart attack, stroke, pneumonia, diabetes, asthma and other chronic conditions.

To learn more:
- Read the TriZetto press release
- See the Health Data Management article on Medicare's bundling demo
- Check out the Prometheus Payment website

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