TriZetto Launches Electronic Record for Health Plans Covering a Third of Americans.

The TriZetto Group, Inc. announced the general availability of its payer-based Personal Health Record (PHR). Now offered to consumers and their physicians through health plans, TriZetto’s PHR is the nation’s first electronic record available to as much as a third or more of all Americans with private health insurance.

Electronic records display a patient’s medical history online to improve efficiency, reduce paperwork and help improve the cost and quality of care. The general availability of TriZetto’s PHR extends to payer customers of its Facets™ enterprise administration software, covering 90 million licensed members. Health plans using TriZetto’s QNXT™ administration system will be able to deploy the PHR to an additional 16 million people by the summer of 2010, while benefits administrators that use TriZetto’s QicLink™ administration system will be able to make the PHR available to another 7 million individuals sometime during the first half of 2011.

“While there’s much discussion on Capitol Hill and in the healthcare community about the promise of electronic health records (EHRs) and electronic medical records (EMRs), these provider-based tools are years away from broad adoption,” explained Dave Pinkert, senior vice president of product management at TriZetto. “TriZetto’s PHR is available now to improve the efficiency and coordination of healthcare in our country, and it will bridge the gap to EHRs and EMRs.”

TriZetto expects its PHR to “vault ahead” of EHRs and EMRs and benefit the healthcare system sooner because the PHR taps the already digital, very rich healthcare records of procedures and diagnoses in the information systems of health plans to give providers a historical summary, or “health resume,” of patients.

“Not only does TriZetto’s secure PHR automatically populate and update with the clinical information that doctors and hospitals provide when they submit claims to healthcare payers, but it allows consumers to enter information about themselves, their family history and their conditions and medications,” Pinkert said. “Our PHR reduces paperwork and wait time at check-in and provides a shared document that a doctor and patient can use together to manage the person’s health.”

TriZetto’s PHR downloads to the doctor when office staff requests confirmation of a member’s eligibility. It is accessible online to the member, is designed for easy portability, so it follows the consumer when he or she changes health plans.

Unlike an EHR or EMR, which captures a patient’s medical record at just one hospital or medical practice, TriZetto’s PHR captures the patient’s record of care from all the providers that file claims. It therefore provides each treating clinician with a more complete view of the patient’s health history, enhancing the coordination of care.

“TriZetto’s PHR uniquely supports the ‘medical-home’ approach to care, a trend among providers and an element of healthcare reform legislation,” added Pinkert.

TriZetto’s PHR advances TriZetto’s Integrated Healthcare Management (IHM) strategy by tapping the healthcare information in payer organizations to provide physicians and consumers with the right information at the right time so they can make the most informed decisions about medical care. TriZetto defines IHM as the systematic application of processes, shared information and aligned incentives to optimize the coordination of benefits and care for the healthcare consumer.

About TriZetto

Founded in 1997, TriZetto is the leading privately held healthcare information technology company to the healthcare payer industry. With its technology touching half of the U.S. insured population, TriZetto is Powering Integrated Healthcare Management®, the systematic application of processes and shared information to optimize the coordination of benefits and care for the healthcare consumer. The company’s offerings include enterprise and component software, hosting, outsourcing services and consulting that help payers implement and optimize their operations and minimize the risk of bringing to market new products that drive competitive differentiation.  Visit www.trizetto.com.

If Healthcare Were Run Like Retail – It Can Be.

I read an interesting post over on the Action For Better Healthcare blog today that caused me to stop and actually leave a comment. The blog which serves as an advocate for non-profit hospitals and the value of those hospitals, featured a post by Kester Freeman, the retired CEO of the largest integrated healthcare delivery system in South Carolina, Palmetto Health.

In the post titled, “If healthcare were run like retail…” It isn’t, nor can it be, Freeman takes on one of the icons of consumer-driven health care, Regina E. Herzlinger the Nancy R. McPherson Professor of Business Administration Chair at the Harvard Business School. She was the first woman to be tenured and chaired at Harvard Business School and the first to serve on a number of corporate boards. She is widely recognized for her innovative research in health care, including her early predictions of the unraveling of managed care and the rise of consumer-driven health care and health care focused factories, two terms that she coined.

In what will be a five-part series, Freeman promises to dissect Herzlinger’s recent article for BusinessWeek, If healthcare were run like retail…, in which she argued that a consumer-driven system would cut costs and improve service.

It the fist of the series, appearing today, Freeman takes on the first point in Herzlinger’s ideal world scenario: “Consumers tailor their own healthcare coverage, navigating in a national insurance market.”

While the Business Week article does not go into any detail about what the professor means by this statement, Freeman writes,

I think it’s rather unrealistic to believe that consumers have the in-depth knowledge required to accomplish such a feat. As Eugene Borukhovich wrote in a January 3 blog entry, most people have yet to establish a personal health record (PHR), such as Google Health or Microsoft HealthVault. Even if set up, the lack of providers that are technologically advanced to synch up with these PHRs makes true accessibility near impossible. Additionally, data and information on procedures, costs, and payer reimbursement that can be obtained by consumers through simple Internet searches has yet to exist. Patients aren’t doctors. Patients aren’t insurance companies. How can a patient-or in Herzlinger’s words, consumer-be expected to intelligently navigate such extensive choices and clinical detail with limited information and knowledge?”

That is where I had to clear my throat and leave a comment. I mean what does tailoring health care coverage have to do with PHRs?

Here’s what I wrote:

I think the issue of being able to tailor one’s own coverage by navigating a national health insurance market is being misconstrued and overcomplicated in the above post. What this really boils down to is having the choice about what you as an individual want to have covered. Today, in addition to basic coverage, each state Department of Insurance mandates all sorts of medical procedures be covered in policies sold in that state. Not to pick on anyone, but mandated coverage for chiropractic visits is a good example, and these mandates add to the cost for everyone. I for one have never been to a chiropractor. So, if given the choice not to buy this coverage, I would forgo it for the premium savings. Or, maybe choose to spend the savings on increased vision benefits because my back is fine, but my eyes need help. This is not that much different than deciding whether to add towing to your car insurance. I would think most people with a high school education can reasonably be expected to be able to make that kind of choice.

I attended the New Product Design & Development in Chicago this past October and heard first-hand several major health plans report on how they have already developed the ability to deliver just such tailored products.

The technology is there, the market demand is there, now all we need are willing DOI’s and health systems.