NEWPORT BEACH, Calif. - November 17, 2009 - The TriZetto Group, Inc. today announced the availability in early 2010 of a new solution to address industry and public demand for better cost and quality of care. The TriZetto Value-Based Benefits Solution is health benefit administration and incentive management software that will 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.

"Employers, benefit consultants and the government are calling for value-based benefit designs to align consumers' incentives to improve health and reduce unnecessary healthcare costs," said Jeff Rideout, M.D., chief medical officer and senior vice president of cost and care management at TriZetto. "With TriZetto's Value-Based Benefits Solution, healthcare payers will be able to meet this demand and differentiate themselves. By enabling this technology for the payers using TriZetto enterprise administration systems, we are poised to very rapidly make value-focused, incentive-based healthcare a reality for more than a third of the U.S. population."

With its Value-Based Benefits Solution, TriZetto brings to market the first and only such solution that leverages new capabilities within TriZetto's Facets® and QNXT™ enterprise administration systems to automate the process of administering value-based benefits for up to 106 million Americans.

"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."

Early value-based benefits pioneers have demonstrated the value of incentive-based programs over time.

"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.

Available on a licensed or hosted basis, TriZetto's solution will power applications that are used by a payer to administer comprehensive value-based benefits programs and by its members to view incentive benefit options and activity. The Value-Based Benefits Solution will join a suite of TriZetto tools that includes the Treatment Cost NavigatorTM web application, which provides consumers with real-time calculation of member liability as opposed to estimates, and the Provider POS DirectTM web application, which gives providers real-time member liability and claims adjudication at the point of service.

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 ManagementTM, 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.

MEDIA CONTACTS:

Loren Finkelstein
The TriZetto Group
303-542-2460
loren.finkelstein@trizetto.com

Melissa Bruno
Schwartz Communications
781-684-0770
trizetto@schwartz-pr.com