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Value-based reimbursement models are rapidly gaining prominence as payers look to reward the value, not volume, of care delivered. Bundling payments based on episodes of care can help reduce unwarranted variations and more accurately predict medical costs. However, transforming existing fee-for-service claims into episodic-based payments can add significant administrative burden and cost.
NetworX Payment Bundling Administration (PBA) solution enables payers to develop and administer highly automated prospective and retrospective payment-bundling programs that can help improve the cost and quality of care while enhancing payer/provider relations with efficient reimbursement. The solution integrates with Facets®, QNXT™ and non-TriZetto® core administration systems to aggregate and price bundles in real time during the claims adjudication workflow and to identify quality and efficiency indicators.
As value-based reimbursement models become more prevalent across commercial- and government-based programs, payers need support to effectively build, manage and evaluate episodes of care to include in bundled-payment arrangements. The NetworX Payment Bundling Administration Analytics (PBAA) solution allows users to evaluate new episode opportunities, review provider performance and manage contracted episodes of care.
Based on bundled claims data generated by the NetworX PBA engine, and leveraging the Tableau Business Intelligence tool for data visualization and report views, payers can:
TriZetto NetworX PBAA is an integral component of Cognizant’s TriZetto Healthcare Products portfolio of solutions designed to help payers and providers enter into payment bundle arrangements to reduce costs, improve quality and achieve better outcomes.