ing can help payers place renewed emphasis on customer service, value-added products and operational effi ciencies. Like any industry in the midst of change, the payer industry will fi nd that pivoting requires additional IT investment. Investing in technologies that leverage ICD-10 coding to optimize healthcare management will help these organiza- tions capitalize on new opportunities and gain long-term rewards. Compliance with the ICD-10 mandate presents health plans with a larger opportunity to improve adminis- trative effi ciencies and: • Pursue avenues to increase Medicare and Medicaid re- imbursement;
• Refi ne payment policies for groups (e.g., diagnosis-related and ambulatory-patient);
• Increase the amount of data used to help the underwrit- ing team manage risk;
• Support value-based benefi t and value-based reimburse- ment programs (such programs use software and service solutions to encourage proven, individually appropriate medical services and discourage unwarranted variations in care); and
• Improve claims subrogation. TriZetto keeps a close eye on reform mandates to ensure that its products are optimized to help health plans meet
changing requirements and seize competitive advantages. TriZetto can support payers in effectively navigating new standards, regulations and positioning to take advantage of the many opportunities that lie ahead.
Health plans that quickly change, adapt and leverage technology to comply with mandates likely will be the fi rst to improve patient-care processes and streamline administrative functions.
“Today, loving change, tumult, even chaos is a prerequi- site for survival, let alone success,” writes business author Tom Peters.
Health plans that quickly change, adapt and leverage technology to comply with mandates likely will be the fi rst to improve patient-care processes and streamline administra- tive functions. They also will be best positioned to become service organizations that manage member health and well- ness as well as managing claims.
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