What is FACETS in Healthcare?

Have you heard the term ‘FACETS’ in a healthcare setting and wondered what it is?

FACETS is a core administration solution for health plans, developed by TriZetto®. It automates common healthcare administrative tasks, including claims processing, billing, care management, and network management workflow.

FACETS was born out of the necessity for a solution that allowed health plans to adapt to new industry trends without system limitations.

From new payment models and changes to contract arrangements with providers to security challenges, members’ needs for personalized health information, and more – the FACETS information technology (IT) platform allows the healthcare industry to embrace these new changes quickly and easily.

In this article, we’ll take a closer look at FACETS, as well as share everything you need to know about FACETS in healthcare and what it means for you.

Who uses FACETS in healthcare?

Over 540 companies currently use FACETS, with 87% of these being based in the US. Of all the companies that are using TriZetto FACETS, 19% are small (fewer than 50 employees), 42% are medium-sized and 38% are large (containing greater than 1000 employees). When we take a closer look at the companies using this IT platform, many of them belong to the following industries:

  • Computer Software (26%)
  • Hospital & Health Care (20%)
  • Information Technology and Services (15%)
  • Insurance (10%)

(Data: enlyft)

In terms of the healthcare industry, FACETS serves 3 main segments: payers, pharmacy benefit managers, and providers.

Payers

Payers are companies that pay for an administered medical service, such as UnitedHealth Group, Anthem, or Cigna.

In order to thrive, payers must transform their business to meet the shifting demands of the healthcare market, particularly surrounding challenges such as emerging care and payment models, incentive realignment, and rapid advances in digital technologies. As a digital healthcare solution, FACETS helps payers engage and retain their customers.

Pharmacy benefit managers

Pharmacy benefit managers (also referred to as PBMs) are companies that manage prescription drug benefits on behalf of health insurers, Medicare Part D drug plans, large employers, and other payers.

With the digital era comes additional competition that threatens how PBMs operate and offer value to their consumers. FACETS helps pharmacy benefit managers to deliver targeted and highly personalized services in innovative ways, helping them to gain a new competitive advantage in a changed world.

Specifically, the platform does this through functions such as regulatory compliance solutions, clinical management programs, business intelligence systems, and implementation advice.

Providers

FACETS helps healthcare providers –  including physician practices, hospitals, and health systems – to make patient care more interconnected, streamlined, and efficient. It does this through providing consulting, operations, and technology services to help launch, scale, or enhance virtual health.

FACETS achieves this through embracing AI and Analytics, Intelligent Process Automation, Security, and Cloud Infrastructure Services.

What FACETS aims to provide to the healthcare industry

The FACETS platform concentrates on 4 key feature areas. We explain each of these, as well as what they involve, below:

1. Market vision

  • Simplifying provider management and risk sharing
  • Enabling value-based relationships, risk adjustment, and quality improvement with real time integration
  • Complying with changing regulations and security standards
  • Offering more flexible payment options and risk stratification

2. Intelligent operations

  • Increasing automation across the system with rules-based configuration, which frees staff to focus on processes that require human intervention
  • Accelerating speed to market by quickly spinning up new products, benefits, and lines of business
  • Renewing plans automatically to reduce administrative tasks
  • Enhancing users’ productivity with dashboards that display significant information

3. Optimized experience

  • Improving customer service and reducingdependency on batch processes through Billing 360 and Real-Time Billing features
  • Leveraging Benefit 360 with a real-time Benefit Summary and information on members’ benefit usage
  • Streamlining intuitive navigation with customized content for users, personalized configurable workspace for improved productivity, and an advanced search capability

4. Enabled enterprise

  • Extending the FACETS solution through third-party integrations
  • Sharing data across TriZetto Healthcare Products to orchestrate the enterprise, reduce redundant data, and decrease timing inconsistencies across systems
  • Storing information in the cloud, either on Cognizant’s private cloud or a public cloud of choice
  • Delivering decision-time insights by applying machine learning and AI to core processing
  • Enabling automation that leverages real-time data publishing

Real-world examples of FACETS being used within the healthcare industry

To further explain what is FACETS in healthcare, we’ve provided two brief, real-world case studies below. These reflect how just two large companies within the healthcare industry are using this IT platform to their advantage, and what it means for their consumers.

Achieving strategic growth objectives

Geisinger Health Plan (GHP) wanted to develop new product lines and enlarge its market presence. However, with a 20-year-old core administration system in-use, their outdated technology could not accommodate its advanced business expansion strategy.

By leveraging the FACETS core system, GHP was able to achieve the following:

  • Better support for compliance and other external market demands
  • A streamlined workflow
  • Increased automation
  • A reduction in errors
  • Processes and systems which were now inline with the health plan’s long-term strategic goals, including participation in programs such as Health Information Exchanges

There was a 10% increase (from 75% to 85%) in auto-adjudication rates. GHP also achieved 100% on-time submissions to Centers for Medicare & Medicaid Services, as well as 99% provider payment accuracy.

Improving accuracy, efficiency, and performance

SelectHealth was planning a transition to Medicare Advantage enrollment to serve the community in a better and more efficient way. Additionally, they were seeking a long-term solution that would help them meet the Centers for Medicare and Medicaid Services compliance standards.

Their existing processes meant the move would be difficult, costly, and inefficient, however by making the switch to FACETS technology (more specifically, the Enrolment Administration Manager  solution), SelectHealth were able to achieve the following:

  • Increased reporting functionality and efficiency
  • More efficient and accurate financial reporting
  • More detailed discrepancy reporting
  • Reduced redundancy

If you have a question about FACETS or other healthcare topics, please contact us!

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