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Managed Care Technology Expert Predicts Profound Changes to U.S. Healthcare System in 2007

Posted on: Thursday, 18 January 2007, 09:01 CST

Profound changes are in store for the U.S. healthcare system in 2007, according to Jeff Margolis, chairman and CEO of The TriZetto Group Inc. (Nasdaq: TZIX), whose technology touches nearly 50% of the U.S. insured population. A 20-year leader in developing information-technology systems for the managed-care industry, Margolis offers his top predictions for next year and beyond:

1. A looming wave of bad consumer healthcare debt will generate demand for real-time, point-of-care claims adjudication systems that generate accurate consumer payment amounts. As consumers shoulder more of the cost of their healthcare services, providers will face a potentially crushing load of growing accounts receivable and bad debt. Determining the accurate amount a patient owes for these services -- in real time and at the point of care -- will drive the most profound changes experienced in the U.S. healthcare system over the past several decades. These changes will involve consumer behavior, as well as health plan and provider relationships and costs.

2. ICD-10, the next "Y2K" for health plans, will be a significant catalyst for upgrading core administrative systems. Legislation is being finalized with compliance dates to move the healthcare industry from a nine-digit coding system to ten. Under ICD-10, diagnosis and treatment codes will increase to 10 digits in order to provide suitable coding options for current and anticipated technology and medical advancements. As was true with Y2K, major systems upgrades will be required across the entire healthcare industry, and some existing systems won't be up to the task. Health plans will need to pay close attention, upgrading their core administrative systems and adding integrated, high-capability provider network modeling and contracting capabilities in response to ICD-10.

3. Changes on Capitol Hill from the 2006 mid-term election won't alter the fundamental forces that are driving broad changes in the healthcare industry. These forces include the Baby Boom population's rolling into Medicare, the growing affordability crisis, and continued cost-shifting from employers to employees. While new players and power structures will drive tinkering and tuning of the healthcare system, healthcare information technology will continue to provide the most potent tools to improve care, drive waste out of the system, and reduce healthcare costs.

4. Health plans will accelerate their efforts to become trusted healthcare partners to consumers, by clearly differentiating themselves in terms of insurance value, pricing, access and information. Understanding the consumer retail world, health plans will continue to surpass their historical role as "administrative scorekeepers" and shift their internal focus to that of true health and wellness facilitators. For example, health plans will help consumers learn or "unlock" what the payers already know about evaluating the cost and relative value of physicians, hospitals and care.

5. Providers and health plans will be surprised to learn that consumers will drive their own definitions of quality. Across the healthcare industry, there are many efforts underway to codify quality. As clinicians debate over clinically-defined quality measures and terms, few appear to be sufficiently involving consumers, who may have some very different ideas for defining quality healthcare. For example, the time spent in the waiting room may ultimately be as important qualitative factors for consumers as the clinical measurements of procedural outcomes.

About TriZetto

With its technology touching nearly half of the U.S. insured population, TriZetto is distinctly focused on accelerating the ability of healthcare payers to lead the industry's transformation to consumer-retail healthcare. The company provides premier information technology solutions that enhance its customers' revenue growth, increase their administrative efficiency and improve the cost and quality of care for their members. Healthcare payers include national and regional health insurance plans, and benefits administrators that provide transaction services to self-insured employer groups. The company's broad array of payer-focused information technology offerings include enterprise and component software, hosting and business process outsourcing services, and consulting. Headquartered in Newport Beach, Calif., TriZetto can be reached at 949-719-2200 or at www.trizetto.com.

Important Notice Regarding Forward-Looking Statements

This press release contains forward-looking statements that involve risks and uncertainties. The forward-looking statements are made pursuant to the safe harbor provisions of the Private Securities Litigation Reform Act of 1995. These forward-looking statements may include statements about future revenue, profits, cash flows and financial results, the market for TriZetto's services, future service offerings, industry trends, client and partner relationships, TriZetto's operational capabilities, future financial structure, uses of cash, the closing of and anticipated dilution or accretion of the QCSI acquisition, and other acquisitions or proposed transactions. Actual results may differ materially from those stated in any forward-looking statements based on a number of factors, including the ability of TriZetto to successfully integrate the businesses of TriZetto and its acquisitions or partners; the contributions of acquisitions to TriZetto's operating results; the effectiveness of TriZetto's implementation of its business plan, the market's acceptance of TriZetto's new and existing products and services, the timing of new bookings, risks associated with management of growth, reliance on third parties to supply key components of TriZetto's services, attraction and retention of employees, variability of quarterly operating results, competitive factors, other risks associated with acquisitions, changes in demand for third party products or solutions which form the basis of TriZetto's service and product offerings, financial stability of TriZetto's customers, the ability of TriZetto to meet its contractual obligations to customers, including service level and disaster recovery commitments, changes in government laws and regulations; and risks associated with rapidly changing technology, as well as the other risks identified in TriZetto's SEC filings, including, but not limited to, its annual report on Form 10-K and quarterly reports on Form 10-Q, copies of which may be obtained by contacting TriZetto's Investor Relations department at 949-719-2225 or at TriZetto's web site at www.trizetto.com. All information in this release is as of January 18, 2007. TriZetto undertakes no duty to update any forward-looking statement to conform the statement to actual results or changes in the company's expectations.

Source: Business Wire

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