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The Truven Health Blog

The latest healthcare topics from a trusted, proven, and unbiased source.

Employees Lose Average of Six Days to Sick Time Each Year

By Truven Staff/Tuesday, November 24, 2015


According to a recent study by the National Business Group on Health (the Business Group) and Truven Health Analytics, total lost workdays averaged six days per employee in 2014 for all industries. For an employer with thousands of employees, that can equate to significant lost productivity. 

EMPAQ® (Employer Measures of Productivity, Absence and Quality™) is an employer-developed and -driven measurement tool. Incidental absence, one of the categories we researched, allows employers to see the impact of unscheduled leaves on the overall company. Here are some more incidental absence details from the EMPAQ research:

  • The healthcare industry’s higher incidence of lost workdays (12 per employee versus the all-industry average of 6) may be an indication of generous sick leave policies or the nature of the job, which can involve engaging with populations suffering from contagious illnesses.
  • The hospitality and retail industry had the second lowest incidental absence rate, at 2.3 days per employee
  • Employers experienced total FMLA leaves of 19.6 per 100 covered employees in 2014. This varied from a low of 12.8 in the pharmaceutical industry to a high of 27.7 in the hospitality and retail industry
  • Employers experienced 164.3 non-concurrent FMLA leaves per 100 covered employees in 2014.
Put the EMPAQ® Data to Work 

It’s important to know statistics about the management of absence, health, and productivity programs. But it’s even more important to use the data to improve the company:

  • Allow employees to work from home when possible to give them the option to manage their personal life without taking time off.
  • Determine whether certain locations or departments have a higher rate of incidental absences to pinpoint areas of focus and come up with a resolution.
  • Implement or improve absence notification processes to help determine which employees take the most incidental absences.

EMPAQ provides employers with a framework to measure and monitor the return on investment from human capital investments. The EMPAQ insight report delivers an overview of the EMPAQ metrics for program year 2014. It was developed by analyzing responses to EMPAQ surveys from more than 100 large employers representing nearly 4 million employees. For more information, download the Insights Report or visit 

The EMPAQ data collected for 2014 included information for four distinct categories, including Incidental Absence and Family Medical Leave, and six key health and productivity programs. Organizations that participate in the survey process receive a customized benchmarking report. Download more information here.



Two Minutes to Claims Auditing

By Truven Staff/Monday, November 02, 2015
With Marie Bowker, Senior Director, Payment Integrity, Truven Health Analytics

Why are plans more concerned now than ever about auditing their claims administrators?

Now more than ever, plan sponsors are concerned with auditing their claims administrators because of two key factors:

  • We all know healthcare reform is here to stay, which means the Cadillac Tax is coming up in 2018, and plan sponsors need to do all they can to minimize and reduce costs.
  • Plan designs have become more and more complex over time, and there’s always the question of whether or not the claims administrator can truly administer the plan design that the plan sponsor has chosen.

What are the top mistakes plan sponsors make when it comes to claim auditing?

The biggest mistake plan sponsors make around claims auditing is they accept the audit rights language in the claims administrators’ typical contract. This means they’re signing up for claims audits that are restrictive in terms of recoveries, time limits, or the ability for the actual claims administrator to recover. The other key mistake is that they wait three or more years before conducting claims audits.

When is an audit of 100 percent of claims preferable over an audit of a random or stratified sample?

A stratified random sample audit works very well for measuring claims administrator performance against their contractual guarantees.  However, a 100 percent of claims audit approach is much better for measuring true performance of the carrier. It identifies duplicates, detects patterns of fraud, waste and abuse, and makes sure they’re following the parameters of the plan design. Today’s technology fully supports the 100 percent of claims approach, followed by an on-site audit of a focused sample of claims as opposed to a random sample.

What can plan sponsors to do stop leaving money on the table?

To stop leaving money on the table, plan sponsors should:

  • Start negotiating more favorable contract language with their plan administrator. After all, it is the plan sponsor’s money and they want to make sure their interests are protected.
  • Conduct a formal audit at least annually if not continuously to monitor, catch and correct problems as early as possible.
  • Continue to raise the performance bar for their claims administrators, making sure the claims administrator is continually improving the quality of their services and adhering to industry standards  
Don’t know where to begin? Contact us here.

Time is Running Out for Health Plans to Meet the CMS Cost-Sharing Reduction Reconciliation Requirements

By Marie Bowker/Tuesday, October 20, 2015

Back in February, when the Centers for Medicare & Medicaid Services (CMS) announced it would delay reconciling 2014 benefit year cost-sharing reductions (CSRs) until April 2016 rather than the previously stated April 2015, many health plans breathed a sigh of relief. Now, there would be time to comply with this complicated requirement, to ensure that their reconciliation projections are accurate, and their data and processes are working correctly. Have you made the most of this extra time? 

Under the Affordable Care Act, all issuers of qualified health plans (QHPs) must provide cost-sharing reductions to eligible enrollees and will be reimbursed for the value of the CSRs. For health plans, cost-sharing reduction plans present one of the most complicated compliance tasks to come out of the ACA. The law requires that health plans:

  • Determine and make payments to approximate the value of the cost-sharing subsidy
  • Declare, before the start of a plan year, which reconciliation methodology (Simplified or Standard) they’ll use
  • Reconcile all advance payments and actual subsidies at the end of the year
  • Complete an actuarial validation process and certify all results (if using Simplified method)
  • Re-adjudicate 100 percent of claims (if using Standard method)

CMS will reconcile 2014 benefit year cost-sharing reductions for all issuers beginning on April 30, 2016, along with the 2015 plan year reconciliation. When it extended the reconciliation deadline, CMS also announced that it would allow those that had selected the Simplified methodology to switch to the more accurate Standard methodology. In announcing the move, CMS acknowledged that the Simplified methodology was yielding inaccurate CSR estimates for a number of issuers, and that many issuers using the Standard methodology were facing difficulties upgrading their systems in time for the reconciliation deadline.

Health plans that have continued to push this requirement to the back burner are running out of time. But all is not lost. You still have six months to make the switch from Simplified to the Standard method. And if you’re still struggling with the re-processing requirements of the Standard method, it’s time to select a partner to take on this important task for you. There’s too much money at risk to be anything less than fully prepared and compliant, for the April reconciliation deadline. Contact us for more information.

Marie Bowker
Senior Director, Practice Leadership 

Highlights From the National Business Group on Health's 29th Annual Conference

Event Focuses on Best Practices for Health, Productivity, and Human Capital

By Truven Staff/Tuesday, October 13, 2015

The National Business Group on Health’s (the Business Group) 29th Annual Conference on Health, Productivity, and Human Capital, highlighted best practices and top solutions for your company's most pressing workforce health and productivity issues.

Truven Health Analytics was a sponsor of the conference. Here are a few highlights from this year’s event:

  1. EMPAQ® (Employer Measures of Productivity, Excellence, and Quality) research findings – Truven Health and the Business Group partnered to collect EMPAQ survey data to help employers quantify the costs of poor health, low productivity, and absence. The survey results provide employers with a framework to monitor and measure the return on investment they’re receiving from their human capital investments. We released our findings during a breakout session on Oct. 7. For more information or to find out how to participate in the survey and receive a customized report, email or visit

  2. Health Leadership & Business Excellence winner announced – During a lunch session on Oct. 6, the Business Group announced the winner of the 2015 award: Cerner Corporation. The Business Group and Truven Health partnered to create this award to recognize excellence and efficiency in corporate health and productivity programs. Through its 2014 EMPAQ submission, Cerner outperformed other large employers in the administration of its health and productivity programs. Across multiple programs measured by EMPAQ, Cerner showed strong business outcomes around incidence, cost, and lost work days.

  3. More than 90 professionals attended our client’s breakout session on measuring ROI in wellness programs – On Oct. 7, CVS Health and Prudential Health clients shared details of their wellness strategies and analytics measures illuminating how they use analyses to develop business objectives and measure results.

Contact us for more information on The National Business Group on Health’s 29th Annual Conference on Health, Productivity, and Human Capital, or to find out more about our solutions. 

Reflections from Visits to Three Manufacturers that Built Cultures of Health

Previously posted on

By Ron Z. Goetzel/Thursday, October 01, 2015

As jobs continue to be outsourced, employers seek workers who have the skills and “know-how” to run complex manufacturing processes. They also seek workers who are “present” and engaged in their jobs, both physically and emotionally. Our visits to three manufacturing companies highlighted key elements necessary for building healthy company cultures.

First, success is hinged on a commitment by leaders to establish a healthy company culture at all levels of the organization. Senior management needs to be part of the wellness committee and not simply delegate the task to employees who lack the authority to make critical operational decisions.

Second, creating a “culture” as opposed to implementing a “program” was a message repeated throughout our visits. A central element of culture, expressed by employees, is a sense of trust between labor and management. This is experienced in the form of collaborative work groups, profit-sharing arrangements, good medical benefits, fair wages, open communications, and a safe work environment. Interwoven into that culture is the often-repeated mantra: “being healthy allows you to enjoy the fruits of your labor.”

Third, a healthy company provides plentiful resources for leading a healthy life. Whatever your personal mission in life – to be a good parent or husband, to contribute meaningfully to your community, to follow your faith or religion, to do good in the world – it can only be achieved when you are not distracted by health problems. As an old proverb reminds us, “Many people spend their health for wealth, and then try to spend their wealth for health."

Finally, successful programs abound when they directly address the strategic and operational goals of the organization in which those programs reside.  Additionally, they need to directly address and respond to the personal health improvement goals established by workers.  Having a health promotion program in and of itself cannot be the end goal; the program needs to support the company’s mission and vision in a very direct and explicit manner.  When asked why the company sponsors a workplace health promotion program, all employees, including executives and line workers, should have a ready answer – to improve the health and well-being of individual employees, and the organization that employs them. 


Written by Ron Goetzel, Truven Health Vice President Health and Productivity Research, with support by the Robert Wood Johnson Foundation