TriZetto's Network Executive Summit Provides Nation's Health Plans with Insight on Managing Provider Relationships Efficiently, Profitably
Unique Venue Addresses Future of Provider Relations, Pay-for-Performance Programs, Medicare Pricing Challenges, and Convergence of Network and Care Management
NEWPORT BEACH, Calif. – February 28, 2007 – The TriZetto Group Inc. (NASDAQ: TZIX) continued its leadership in the health plan market this week with its 4th Annual Network Executive Summit, attended by health plan leaders representing more than 100 million insured individuals across the country. Understanding that trends such as pay-for-performance programs and other healthcare cost and quality initiatives involve multiple business areas within a health plan, TriZetto's theme for the summit was "Improving the Cost and Quality of Care: The Convergence of Network and Care Management." TriZetto partnered with ChapterHouse, a strategy and consulting firm specializing in healthcare, to produce the summit.
With economic and competitive pressures mounting, health plans are negotiating increasingly complex provider contracts that align provider practices with the health plan's financial and strategic objectives. This emphasis on provider contracting has given rise to a growing health-plan focus on network management - a comprehensive business cycle that includes contract negotiation, financial analysis, credentialing, provider relations, and other critical processes.
"Provider networks and contracts are strategic assets that can really define a health plan's position in the market," said David Pinkert, vice president of Product Management for TriZetto. "But managing provider relationships well is one of the toughest jobs in healthcare. Understanding these challenges, TriZetto has developed the NetworX suite of specialized technology tools to help health plans effectively manage this crucial part of their business. Our clients have used these tools to fully automate their claims pricing and negotiate more creative and complex provider contract terms than their competitors."
At the summit, health plans learned more about TriZetto's NetworX suite of software, which automates provider contracting and execution, claims pricing, and network operations. Currently, 45 health plans representing 67 million individuals, or 33% of the total U.S. insured population, have purchased TriZetto's NetworX products, including NetworX Pricer, which automates even the most complex claims pricing, and NetworX Modeler, a financial tool that health plans can use to predict costs and negotiate strategic provider contracts.
TriZetto's summit, a unique and collaborative venue for participants to discuss market forces and best practices, also featured a workshop on the opportunities health plans have to negotiate Medicare Advantage provider contracts and automate these complex claim payments. The session was conducted by Larry Bridge, senior vice president of Government Programs for TriZetto.
"Given that today's 44 million Medicare beneficiaries are expected to grow to 72 million by 2030, it is likely that Medicare fee schedules will become the benchmark for provider negotiations across all of the health plan's lines of business," said Bridge. "Without the ability to understand and model contracts against the latest, up-to-date Medicare prospective payment systems, health plans could likely find themselves at a significant competitive disadvantage."
Tom Main, managing partner of ChapterHouse, kicked off the summit with a keynote presentation on the outlook of the healthcare market, underscoring the impact on health plans, and the importance of understanding the key trends so payers can remain competitive both today and in the future. Another keynote speech by Karen Titlow Linscott, chief operating officer of The Leapfrog Group, helped attendees understand employer needs as health plans develop pay-for-performance programs. The Leapfrog Group is a voluntary program focusing on improving the safety, quality and affordability of healthcare. Its members, including Fortune 500 companies and other large private and public healthcare purchasers, agree to base their purchase of health care on principles that encourage provider quality improvement and consumer involvement.
TriZetto's 2007 Network Executive Summit took place Feb. 26 and 27 at the Harbor Beach Marriott, Fort Lauderdale, Fla. This year's participants included not only health plan network management executives, but also chief operating officers, chief information officers, and chief medical officers, representing both current and prospective customers. For more information about TriZetto's comprehensive health-plan technology solutions, or next year's Network Executive Summit, please visit www.trizetto.com.
About TriZetto's NetworX Suite
NetworX Pricer is a component software application that fully automates claims pricing. Using it, customers can reduce labor costs and experience accurate, fast claims processing. Health plans can use it to support complex contracts and their complicated pricing arrangements. While other pricing systems require specialized computer programming skills, any health plan employee can use the natural language feature of NetworX Pricer to set up and maintain contracts in the system - boosting productivity and efficiency. The software automatically prices claims correctly the first time, eliminating the errors and inconsistencies of manual pricing and reducing the number of calls health plans receive from billing administrators. NetworX Pricer also reduces the duration of customer service calls by generating a complete history of terms used to calculate provider reimbursements, so inquiries are resolved quickly.
NetworX Modeler predicts the financial impact of new or revised provider contracts, improving the efficiency and financial results of the contract negotiation process. The software uses a health plan's real claims data to forecast costs against proposed provider rates and terms. This information can help health plans structure the most strategic pricing arrangements with providers and facilities. Many new types of customized health benefit plans are built on tiered provider networks with a complicated array of fees and services. A sophisticated analysis tool like NetworX Modeler allows health plans to evaluate and negotiate the pricing arrangements for these complex contracts. Once in the system, contracts can be copied and edited to reflect proposed rate changes, which are automatically and accurately analyzed in detailed reports for the health plan. Using this information, health plans can assess which proposed terms are expected to have the greatest financial impact on the business. In addition, the software can be loaded onto a laptop computer, making this critical financial information available during actual negotiations.
Health plans can maximize speed and cost savings by using NetworX Modeler in conjunction with NetworX Pricer: contracts can be moved electronically between the pricing engine and the modeler system, without being rebuilt.
About TriZetto
With its technology touching nearly half of the U.S. insured population, TriZetto is distinctly focused on accelerating the ability of healthcare payers to lead the industry's transformation to consumer-retail healthcare. The company provides premier information technology solutions that enhance its customers' revenue growth, increase their administrative efficiency and improve the cost and quality of care for their members. Healthcare payers include national and regional health insurance plans, and benefits administrators that provide transaction services to self-insured employer groups. The company's broad array of payer-focused information technology offerings include enterprise and component software, hosting and business process outsourcing services, and consulting. Headquartered in Newport Beach, Calif., TriZetto can be reached at 949-719-2200 or at www.trizetto.com.
CONTACTS:
Investor Contact:
Brad Samson
949-719-2220
brad.samson@trizetto.com
Media Contact:
Audrey McDill
303-495-7197
audrey.mcdill@trizetto.com