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

AWS re:Invent 2025 - Transforming Healthcare Payer Operations: AWS-TriZetto Success Story

Payer Operations Transformation Overview

• Modernizing core payer functions like claims adjudication, prior authorization, call center solutions, and utilization management
• Importance of rethinking operations, workflows, and change management during cloud transformation
• Democratization of data through agentive technology and generative AI solutions, enabling self-service analytics

Future of Payer Operations

• Multi-environment claims adjudication systems, with a focus on cloud-native architecture
• Accelerated speed-to-market for new product delivery, reduced from 12-18 months to much shorter timeframes
• Increased regulatory and compliance demands, with faster turnaround and greater impact
• Emergence of new market models, such as value-based care, requiring more technology and faster responses
• Emphasis on defining clear ROI and business outcomes for technology investments

The AWS-TriZetto Partnership

• Partnership launched at re:Invent 2024, driven by customer demand for integrated solutions
• TriZetto is a leading payer software provider, with 70% market share
• Key pillars of the partnership:
  • Cloud migration and adoption
  • AI modernization, including agentive capabilities
  • Product innovation, with 17 key initiatives
  • New managed services offerings

Customer Success Story

• Large Midwestern Blue Cross Blue Shield plan with 375,000 members
• Needed to migrate to a new claims processing platform within 1 year
• Implemented TriZetto's Facets G6 product on AWS, leveraging:
  • Kubernetes (EKS) for containerized application runtime
  • EC2, FSx, and RDS for infrastructure
  • CI/CD automation with Terraform, PowerShell, and GitLab
• Key lessons learned:
  1. Automation was critical, saving thousands of hours
  2. Standardization of environments enabled the automation
  3. Impressive data migration performance, up to 17 million claims per hour

New Product: TriZetto Managed Services

• Turnkey deployment of TriZetto's core Facets and Q-Nest applications on the AWS cloud
• Allows customers to run TriZetto products on AWS, either on TriZetto's or the customer's AWS account
• Provides a new managed services model for payer operations

TriZetto's AI Gateway

• Centralized platform for integrating AI agents across TriZetto's product suite
• Provides visibility, transparency, and auditability for AI-powered capabilities
• Supports both generative and agentive AI models, with the ability to swap models over time
• Exposes model context protocol APIs to enable integration with the broader enterprise

Opportunities for Collaboration

• TriZetto is seeking beta customers for cloud migration and AI-powered solutions
• Interested parties can visit the Healthcare Pavilion or the Cognizant booth to learn more and discuss potential pilots

Key Takeaways

• Payer operations are undergoing a significant transformation, driven by cloud adoption, data democratization, and new market models
• The AWS-TriZetto partnership aims to deliver integrated solutions to accelerate this transformation
• Successful cloud migration and AI modernization require a focus on automation, standardization, and data migration performance
• TriZetto's new managed services and AI gateway offerings provide innovative ways for payers to leverage cloud and AI capabilities
• Opportunities exist for payers to collaborate on cloud migration and AI pilots to drive tangible business outcomes