AWS re:Invent 2025 - Transforming Healthcare Payor Operations: AWS-TriZetto Success Story (IND210)

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Overview

📖 AWS re:Invent 2025 - Transforming Healthcare Payor Operations: AWS-TriZetto Success Story (IND210)

In this video, AWS and TriZetto present their strategic partnership for transforming healthcare payer operations. Srivaths from AWS, along with Rich and Scott from TriZetto, discuss modernizing core claims adjudication systems through cloud migration. Key topics include the five-year collaboration launched at re:Invent 2024, featuring 17 joint initiatives. Rich shares a success story of migrating a Midwestern Blue plan with 375,000 members to AWS in one year using Facets G6 on EKS, achieving 17 million claims loaded per hour. Scott introduces the TriZetto AI Gateway, a new product built on AWS Bedrock that provides centralized agent management across TriZetto's product suite with Model Context Protocol APIs. The session emphasizes automation, standardization, and the new TriZetto Managed Services offering for turnkey deployments on AWS.

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Main Part

Introduction: AWS and TriZetto Partnership for Payer Transformation

Good morning and thanks for joining us today. As part of the payer community, I understand that payer operations, particularly claims operations, are very significant to your organization. I'm Srivaths. I'm part of the Healthcare BD team at AWS, and in partnership with TriZetto, we'll be showing you the transformation of a healthcare payer organization using AWS and the TriZetto solution. I'm joined today by Rich and Scott from TriZetto.

So here's an overview. We'll do a payer overview of what we see in the market. We'll talk about the partnership and why it's valuable to you. We'll identify a customer success story, which Rich will take over. We'll talk about some potential new products in the pipeline that are coming up, and we'll have some Q&A.

So based on our discussions with our customers and our survey of the market, here's where we see areas of focus. Modernizing core functions—what are we talking about here? Clearly claims operations, claims adjudication systems, but also associated and complementary solutions, whether it's for prior authorization, whether it's for call center solutions, or utilization management. One key point I want you all to remember is that this transformation to the cloud will lead to a technology upgrade, but it's also equally important to realize that you may have to rethink your operations, your workflow, and undertake a tremendous amount of change management. Leverage this opportunity to change the way you do business.

On the analytics side, I think the key point there is to understand that there's going to be democratization of data. What I mean by that is users want access to their data. They want it on demand. They want it the way they want it, and they want to be able to ask infinite questions. There is no amount of dashboards you can build that will support that. This is all going to be driven by agentic technology and Gen AI solutions.

If you look at the member experience, the member experience is what I'm sort of referring to as the member bill of rights. Members, customers—they want the right to be able to choose the right channel at the right time, the right way they want a message, whenever they want. So this is a redefinition of how we interact with members, how we engage with members, and ultimately how we improve their experience.

So where do we see the future, the future of claims adjudication systems? One is it's going to be multi-environment. It's going to be systems which will provide operations across some legacy, but mostly on the cloud. It hopes to reduce the complexity of IT environments by about 40%. Why is cloud-native transformation so important? It is important to accelerate speed to market. It is important to be able to deliver new products on demand or within very short time frames. The idea of 12 to 18 months to design and build a new product for payers to deliver is no longer going to be applicable.

The regulatory and compliance market is going to be really changing because I think we're going to see a lot more regulations and a lot faster turnaround with a lot more impact. Right now we're given about two to three years for regulations to take effect. That is going to get crushed. People are going to say, hey, here's the regulation, here's the mandate, comply.

The other aspect of it is the new market models. Now, clearly, value-based care is an alternative model. We're fairly familiar with it, but there are newer models coming out with more technology requirements and greater speed of responses. The idea of ROI—we've talked a lot of technology, we're talking about investments, we're talking about upgrades to solutions, we're talking about making it more feasible for our members to access them, but there has to be an ROI and a well-defined ROI. It is going to take some level of discipline on all of us to say, here's the investment we're making, here's the targeted business outcome. It's not AI, it's not agentic technology for the sake of technology, but we really have some endpoint business outcome.

All of this is going to be framed by member expectations. Members are customers, and customers have choice, so it's important to understand that members and customers are experiencing a certain level of member engagement, member experience. If I can order tickets online, or if I can order food, or if I can get groceries in 30 minutes, I should be able to have a comparable experience of being able to pick a doctor and get an appointment this year, not in the next year. There's still 31 days left, or 30 days left.

The idea really is to say all of this has to be framed with the member experience because ultimately members decide whether we as organizations are successful or not. So what is the partnership and what is it worth to you? Officially, the partnership was launched last re:Invent in December 2024, so we're a year into it. The reason for this is there was a fair amount of customer demand saying, "Hey, you're the best of breed in what you do, so talk to us, get united, give us solutions that make sense from our perspective."

Why we partnered with TriZetto is they've got a key solution, one of the key solutions in the payer operations side in the claims adjudication. They're used by payers to manage the entire value stream from member engagement all the way to reimbursement and cutting of a check. TriZetto is building new solutions directly on AWS. Their products are being optimized for AWS, and you'll hear from Scott and Rich about some of the new products coming down the pipeline. One of them is called the TriZetto AI Gateway, but you'll hear more details about it. Rich, over to you.

Building a Modern Foundation: Four Pillars of the Strategic Collaboration

Thank you. Good morning. I'm Rich Healy. I'm a director in our solution architecture practice. As Srivaths mentions, we've brought together really the two key players in the industry. We've got Cognizant, we've launched this partnership together. We've got Cognizant and TriZetto, the number one payer software entity, 70% of the market. We received the best in class recognition for the solution offering and the product, and this is bringing together Cognizant and AWS, the number one hyperscaler.

To that end, as we build that modern foundation for healthcare, there were four key pillars that we started looking at for how we're going to work together and how we're going to frame the partnership, how we're going to drive innovation for our customers. First was the cloud itself, driving innovation to the cloud, driving adoption to the cloud. We've got a large diverse customer base, different deployment models, private cloud, on-premises models, so we want to unify that migration path to the cloud and provide playbooks, and we're doing that.

We want to drive AI modernization both into the product itself, driving additional co-pilot and agentic capabilities, but also driving it into our operations as we launch new managed services offerings. We're bringing that AI agentic operations flow into the mix from the beginning. We're thinking and looking at use cases like when a batch job fails and there's a specific error condition and perhaps a missing piece of data that we could fix, that we could resolve issues proactively before they're impactful.

Up in the top right, we're driving product innovation, and then as Srivaths mentioned, we're working closely together to drive this. We have 17 key initiatives that we're driving over the five years, and it's been a wonderful experience collaborating with AWS. They bring excellent resources to the table, excellent architects. Our friend Priya Patel, I think she may be out here, great partners that really are helping us forge innovation quickly. We started this last year here at re:Invent, and what we've done in one year, we're launching new managed services offerings and really changing the course of innovation for our payer customers. It's amazing.

Finally, as I mentioned, we're launching new offerings, new products. We have a new TriZetto managed service offering, unique in the marketplace, that allows us to manage the TriZetto product suite and manage your operations, your claims processing, your member enrollment on our AWS account in a hosting style or in yours, working in a forward deploy model. Maybe we want to work in your organization, work in your account to drive innovation and drive better outcomes for your patients. That's why we're here.

The TriZetto piece of this, the strategic collaboration we talked about, is new. We started that last year. It's a five-year agreement, but AWS and Cognizant have been working together for many years, 14 years. The number that stuck out in my head here is 17,000 active, 17,500 active certifications. I've got about six certifications and I know how much hard work that is, but this is the extension of the innovation that we've been doing for a long time. Great partnership, great people to work with, and a pleasure to do business with.

Customer Success Story: Rapid Implementation and TriZetto Managed Services

I want to talk about a customer success story. We started this the year before last. This was a customer that had a unique problem. They had a burning platform, if you will. They had a large book of business that they had to get migrated and implemented onto another platform, onto another system. I heard about this. I've been in the business for about 30 years, and I thought perhaps this would not be a suitable outcome. The customer wanted to get this done in one year and I didn't think we could do it, but we went after it anyway, and we were able to do it. I think driving that project on AWS cloud was the key to our success.

So it was a large Midwestern Blue with about 375,000 members, and they had to get out of that data center. Their contract was expiring, and they didn't have a way to pay claims. If they didn't have a new system by January 1st, they weren't going to be able to meet their business goals.

So we took on the project and implemented our core flagship Facets G6 product on AWS, making use of EKS. It's our full Kubernetes containerized application runtime, EC2, FSX, so all the usual suspects. RDS managed databases made it easy for us to get the data loaded.

We made use of the latest, greatest CICD approaches and cloud native technologies, tools like Terraform, PowerShell, and GitLab to get the thing deployed properly. And that automation that we invested in turned out to be the linchpin of what let us hit these goals, right? Because we automated everything, we were able to get the job done in a timely fashion. If you see all those acronyms down there in the bottom left or bottom right on your side, I don't know if they mean anything to you, but they are bread and butter, right?

Facets is our core claims processing system. The HIPAA gateway is our EDI layer, right? We installed basically the entire TriZetto product suite in a containerized fashion on AWS on time and hit the goals. We were able to get them up, get them integrated. And deliver the solution in a way that I think I didn't think was possible after doing this for many years. I'm glad we did it.

So the three lessons learned, right? Automation. We drove and we spent time driving the automation of the environment deployments so that when we built the dev environment, building the test environment was merely just executing that same set of scripts we had. We built out the pipeline so that the automation was inherent so that deploying another environment was just pushing a button. We saved probably 2,000 to 3,000 hours over the course of that year, right?

We didn't have dedicated teams installing things, clicking. Click ops was dead for us, right? And that's what I think set us free. Standardization allowed that automation. Some of my customers might have two products in one environment, five products in another environment, ten products in another environment. What we found is we kind of took a standardized approach where everybody gets everything, and we build it in dev, and dev looks a lot like prod, but smaller, right?

So we were able to really leverage that automation and standardization to deliver the goods. The data migration performance was outstanding. We hit, I think, the highest numbers. I think it was 17 million claims loaded in an hour with some wild number. And overall, it's a great success story. AWS was with us the whole way, and I think that was key to the success.

Another key part of the product that I want to talk about, a new product launch we're doing, our TriZetto Managed Services offering, right? This is a turnkey deployment of the core TriZetto Facets and QNXT applications deployed on our technology stack, right? On our AWS account, or we can work to deploy it on yours. But this is a new way to run our software on the AWS cloud. Again, I think a key output of our partnership and something we're very proud of. Scott, I'm going to introduce Scott. He's going to talk about another new product.

TriZetto AI Gateway: Bringing Generative and Agentic AI to Healthcare Payers

All right, thank you, Rich. Good morning. Thank you guys for joining. This is absolutely a lightning round. I don't know I've ever heard Rich speak that quickly since I've known him, but what I'd like to do is just take a couple minutes here, talk a little bit about our approach to AI. If you're familiar with TriZetto, if you're a TriZetto customer, welcome. If you're not, just 5,000 foot level. TriZetto is a suite of products. We go across core administration, care management, government solutions, lines of business, et cetera. So it's a pretty wide net of healthcare payor centric solutions.

So as ChatGPT came onto the scene and there was a lot of emphasis on how do you bring generative AI into the enterprise, certainly we reflected on that challenge very deeply. How do I bring generative AI into a heavily regulated, highly accuracy dependent industry? And then the narrative quickly shifted away from not only generative AI but also agentic AI. So we looked at it from both lenses, the role of generative AI versus agentic AI, and then similarly, kind of a dual mandate. How do I bring artificial intelligence into our products, human in the loop or human around the loop, but then also how did the TriZetto assets contribute to the broader identification of the enterprise?

So those are our two high level objectives specific to the solution and deployment into AWS. We invented a new component. It's called the TriZetto AI Gateway. In short, this is where our agents live. So if you think about the proliferation of agent platforms and you've got multiple places to build agents at the enterprise level, when we're talking TriZetto products, TriZetto user interfaces, our agents live inside the gateway. It is command and control.

Our entire portfolio integrates in through a series of APIs. We did this for a number of reasons, but most compelling of all, it gives us a single entry point across the products when you're talking about visibility, transparency, auditability, identity management across our products. It gives us a really nice architectural solve to go after a lot of those non-functional requirements.

It sits on top of Bedrock and a number of models. The models, of course, continue to evolve over time as they mature, and we swap models in and out. From an enterprise perspective, the products themselves have long celebrated open access as a key part of their structure. The next round of open access also includes Model Context Protocol APIs. So we now think about our AI solution really in two contexts: one being the gateway, which is built by us for those use cases that sit in and around the products, and then the individual products exposing their Model Context Protocol compliant APIs as a way to promote the TriZetto assets into the broader identification objectives.

So I'm going to call it there and turn it back to you. I do want to mention really quickly, if you are a TriZetto customer, if you're contemplating migration into AWS, if you're contemplating the role of agents, we went through a number of successful pilots over the last six months. We'd love to pick a few more up as we head into the first quarter of this year. So the gateway went generally available back in Q3 of last year, but we are still in limited availability mode if folks want to jump into that pilot opportunity. So with that, I'm going to turn it back over.

Thank you, Scott. So I just want to put another plug for being a beta adopter for either the cloud migration journey or the AI-based solutions. If you're looking at targeted use cases within functions and say you've got issues in member management versus prior authorization, we'd be happy to talk to you. So another plug, the AWS for Industries Pavilion is catty-corner from here, so a lot of you are on the healthcare side, so please do come by, stop there, and take a look at some of the use cases. We have a bunch of demos that we want to talk to you about, so we're happy to see you there.

That's all we had from a presentation perspective, so if you have any questions, we'd be happy to address them. Going once. No, just kidding. The Cognizant booth is in the back right behind us there too. If you have any interest, we'll be there and happy to take questions and collaborate with you.

All right, well, thank you very much for attending. Appreciate it. Thank you very much for attending. Really appreciate your time. Thank you.

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