QualChoice Health Insurance has implemented TriZetto’s payment bundling solution software to administer episode based payments to physicians who cater cardiac stents, perinatal care and hip and knee replacements for its group and individual health plan members.
The underwriter claims that the new payment model will allow physicians and facilities to share cost savings or incur performance penalties, based on how well they complete episodes of care at appropriate cost and quality levels.
QualChoice has collaborated with Medicaid, other private payers and hundreds of physicians, healthcare professionals and other stakeholders to execute the Arkansas health care payment improvement initiative.
QualChoice president and CEO Michael Stock said QualChoice chose TriZetto’s payment-bundling administration solution as it automates and streamlines retrospective and prospective episodic-payment models.
"Under the state program, physicians and facilities are rewarded retrospectively – months after the service – with shared savings for meeting quality and cost standards for select episodes of care," Stock added.
"TriZetto’s highly flexible solution, which we implemented in just three months, will support both retrospective and prospective payment models, allowing us to continually innovate to improve member health and best serve our employer customers."
The service provider said that a single, episode-payment approach encourages caregivers to function as one team, share information, coordinate treatment and provide patient-centered care.
TriZetto’s patent-pending payment-bundling application automates and streamlines the processing of episode-of-care payments by QualChoice.