Employers, benefit consultants and the government are calling for value-based health benefit designs to align consumers’ incentives to improve health and reduce unnecessary healthcare costs.
TriZetto, a leading supplier of health claims management systems has announced the availability in early 2010 of a new solution to give payer organizations the ability to customize benefits and other incentives for individual members based on their health status, chronic conditions and health and wellness activity.
Value-based benefit designs use financial incentives to encourage members to adopt healthier lifestyles and effectively manage chronic conditions by adhering to recognized healthcare guidelines.
“Incentives, combined with an effective value-based design, are powerful tools in achieving population health improvement,” notes author Cyndy Nayer in the newly released book, Leveraging Health: Improve Health Status and Bend the Trend on Financial Inflation With Value-Based Designs. “Innovators use data to develop an integrated suite of plan design features and incentives that will incrementally improve the health management of populations.”
“The key to successful value-based benefits design is to truly individualize the benefits and claims adjudication to the specific clinical conditions of each high-risk member and to reward participation in health and wellness and appropriate condition management programs,” said Gail Knopf, vice president of enterprise strategy at TriZetto. “Until now, these tasks have required a heavily manual, labor-intensive effort. TriZetto’s Value-Based Benefits Solution will automatically adjust co-pays or coinsurance on specific claims in real time during the plan year based on effective dates of qualifying events — such as a diabetic health plan member completing a course to better understand his or her condition — unlocking the potential of value-based benefits programs to improve member health and productivity and to stem medical cost increases.”
“By incenting the proper use of medications and care services to control high-risk diseases, early adopters of value-based benefits have reduced the total cost of their population health as much as 32 percent below industry benchmarks,” said Nayer.
“While initial programs stressed Rx compliance to manage disease, more sophisticated designs that address pre-emptive medical care for high-risk diseases are now emerging,” Knopf added.
TriZetto is the leading privately held healthcare information technology company to the healthcare payer industry. More information is available on www.trizetto.com.