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The Truven Health Blog


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


Health Plans: Choose Your Initial Validation Audit Vendor Wisely


By Anita Nair Hartman/Tuesday, March 21, 2017


For health plans, the time to select an initial validation audit (IVA) vendor is drawing near. Selecting a qualified vendor should be a thoughtful and informed process. If the audit shows a plan’s EDGE data are not valid and have risk score-impacting errors, the Centers for Medicare & Medicaid Services (CMS) may act to scale down the plan’s premium risk transfer payments, which may incur negative results for the plan’s financial performance. As a CMS-accepted IVA entity, we’ve been partnering with health plans to meet this requirement since the law was implemented.

CMS developed IVA requirements to help ensure that accurate and complete membership and risk adjustment information is submitted by health plans to the EDGE servers for eventual payment transfer calculations. According to the regulations, qualified commercial health plans must have an independent auditor with certified coders review medical records for 200 random members (or less if the Finite Population Analysis applies to the issuer) selected by CMS and must validate the enrollment and the diagnosis codes submitted. The deadline to select a vendor for this year is April 28, 2017.

 Medical records review is a critical part of the validation process, so health plans should consider experience and certification when selecting a vendor. Some other important qualities to look for in an IVA vendor are:

●      Deep knowledge of ACA regulations. A vendor should have a history of monitoring, evaluating, and influencing the changing ACA requirements.

●      Data, analytics, and auditing experience. A long history analyzing large claims databases and auditing healthcare claims, and prior experience with CMS-mandated reporting, are critical experiences.

●      Experience with EDGE servers. To efficiently audit EDGE data, the vendor needs experience with EDGE data format and content, and in processing large amounts of data.

●      Risk and reinsurance expertise. Look for an auditor with experience with risk models.

●      Flexible approach. This is not a completely straightforward process. Every health plan is different, and your vendor should be able to implement a solution to meet a health plan’s specific needs.

●      Certified coders. This one is straightforward. By law, the coders must be certified by the American Health Information Management Association (AHIMA) or the American Academy of Professional Coders (AAPC).

●      An IVA Approved by CMS. Plans must choose from a list of CMS-accepted entities.

Selecting an experienced and qualified partner to support the IVA will help give health plans peace of mind in managing the IVA requirements. If complying with CMS’s EDGE server requirements is taxing your organization’s resources, it’s time to consider partnering with a qualified EDGE server administrator, and IVA vendor, so you can get back to the business of offering quality health care. Contact us to learn more.

Anita Nair-Hartman, Senior Vice President, Payer Strategy and Business Operations
Bryan Briegel, Healthcare Reform Solutions Specialist


The Effects of Telecommuting Intensity on Employee Health

Chosen as AJHP Editor’s Pick for 2016


By Truven Staff/Friday, March 10, 2017

 

The number of employees who take advantage of telecommuting has increased substantially in recent years - especially with the improvements in technology and the increasing demand for more flexible work schedules. The Effects of Telecommuting Intensity on Employee Health, recently chosen as Editor’s Pick for 2016 by the American Journal of Health Promotion (AJHP), highlights how the employees at Prudential Financial, a company with a long history in promoting work flexibility are affected by telecommuting - specifically in relation to their overall health.

Over a two-year period, Prudential Financial, in partnership with Truven Health Analytics®, IBM Watson Health™ analyzed the amount of time employees spent telecommuting and what potential health risks arose because of it, including depression, stress, poor nutrition, physical inactivity, tobacco use, alcohol abuse, and obesity.

The research suggested that telecommuters had a lower risk of developing many medical ailments, including obesity, alcohol abuse, physical inactivity, and tobacco use. The study also found evidence that employees who engage in a small number of telecommuting hours were less likely to develop depression. While the study provided some evidence to suggest that flexibility with telecommuting has health benefits, maintaining some level of in-office work may help to strengthen spiritual and social health.

 Download the full study here.

 


Some of our highlights from HIMSS 2017


By Truven Staff/Monday, February 27, 2017

Last week, representatives from Truven Health Analytics, now part of the IBM Watson Health business, and more than 40,000 health IT professionals, clinicians and executives attended HIMSS 2017 in Orlando, FL to learn from health industry leaders, see the newest products and services and get an idea of what’s ahead in healthcare.

Here are some of our highlights from this year’s HIMSS conference:

  • Launch party for Portable Analytics and new cognitive offerings: Truven Health Analytics and IBM Watson Health celebrated the launch of several new offerings, including Portable Analytics. This is an enterprise analytics solution that enables health plans to embed robust analytic content from Truven Health into their own technology environments. A similar offering is available for providers.
  • Speaking session in IBM Presentation Theater: You’ve got the data, now get the answers: Truven Health and IBM experts Kevin Ruane and Rich Hennessy, respectively, showed a diverse audience of healthcare stakeholders how they can improve performance through data and insight with our portable analytics. Click here to schedule a demo and see for yourself.
  • Black Book award for population health solution: IBM Watson Health was recognized by Black Book™ for its best-in-industry population health solution. Click here to read an article about the Black Book™ best-of-breed study.

Contact us to learn more about our new solutions that were unveiled at HIMSS 2017.

 


Workplace programs, policies and environmental supports to prevent cardiovascular disease


By Truven Staff/Tuesday, February 7, 2017

Ninety-nine percent of the U.S. population has at least one of seven cardiovascular health risks: high blood pressure, high total cholesterol, high blood glucose, unhealthy body mass index (BMI), tobacco use, physical inactivity, or poor diet.[1] The combined contribution of these risk factors increases employer medical spending by 213 percent per person per year.[2]

“Organizations need to assess their heart health programs, policies and environmental supports to reduce health risk factors for cardiovascular disease, lower the prevalence of the illness, and reduce medical expenditures,” said Ron Z. Goetzel, Ph.D., vice president of consulting and applied research at Truven Health Analytics, an IBM Company.

The American Heart Association (AHA) offers the Workplace Health Achievement Index (WHAI) to help organizations perform these assessments. Last year we connected organizational WHAI measures to individual employee medical, drug and health risk data housed in the Truven Health MarketScan® multi-employer database, and together we analyzed the data.

Results from the study

Twenty large employers participated in this study to assess the association between organizational health and measures of cardiovascular health risks, disease prevalence and medical costs. Some results of the study included:

  • One fifth of employees have cardiovascular disease, with an average per member per year spending of $329 for the disease
  • The most common health risk for these workers was unhealthy weight (72% prevalence), followed by poor diet (71%) and high blood pressure (66%)
  • The least common health risk was tobacco use (5.5%), which was substantially lower than that for the U.S. adult population (16.8%)
  • A higher WHAI score was associated with lower prevalence of four modifiable health risk factors: high blood pressure, high cholesterol, tobacco use, and physical inactivity
  • WHAI scores were not correlated with high blood glucose and unhealthy weight, but were positively correlated with poor diet
  • A higher WHAI score was associated with lower cardiovascular disease prevalence but higher cardiovascular disease spending, a result meriting further study

Though there is no clear pattern as to which organizational health factors are associated with better outcomes, we encourage employers to participate in the next wave of multi-employer studies that aims to look at trends in organizational programs, policies and environment, and how these support a healthy lifestyle among workers[SE1] [GRZ2] .

What can employers do with these results?

  • Employers can act now! There is no need to wait for more research before implementing evidence-based health promotion programs proven to positively influence employee health and well-being.
  • When implementing a program, remember to always measure and evaluate.  This can be done by designing “dashboards” that track key program structure, process and outcome measures for the organization.
  • Finally, employers can experiment with different health promotion strategies at different business units/locations and track the effectiveness of alternative models.

Dr. Goetzel presented the study findings at a briefing event sponsored by Health Affairs on Tuesday, February 7, 2017 at the National Press Club in Washington, DC.  For more information, click here.

 

[1] Ford ES, Greenlund KJ, Hong Y. Ideal cardiovascular health and mortality from all causes and diseases of the circulatory system among adults in the United States. Circulation. 2012;125:987-995.

[2] Goetzel RZ, Pei X, Tabrizi MJ, Henke RM, Kowlessar N, Nelson CF, et al. Ten modifiable health risk factors are linked to more than one-fifth of employer-employee health care spending. Health Aff (Millwood). 2012;31(11):2474-84

 

 

 


The EDGE Server Data Submission Requirement Is Alive and Well. How Is Your Process?


By Truven Staff/Wednesday, February 1, 2017



Although the future is always uncertain, there are ongoing, complex reporting requirements we know health plans must meet in 2017. EDGE server data submissions are as challenging as ever, and health plans must submit complete 2016 benefit year data by May 1, 2017. 

Accurate and complete data submissions are a must to ensure that you present the actual risk of your member population and maximize your reinsurance and risk transfer payments. Was your EDGE server software stack upgraded to the new CMS requirements by January 31, 2017 – and are you feeling prepared? We think a few key questions to ask are:

  • How well is our approach to EDGE working?
  • Did we have clean data that optimized our risk adjustment efforts?
  • Were we able to respond effectively to the ongoing changes in CMS requirements? Most recently, how has our CMS-required EDGE server re-imaging and software stack upgrade gone?
  • What improvements do we need to make to maximize our return on our EDGE efforts?

The difficulties in accurately capturing and presenting your members’ risk and effectively processing EDGE data become abundantly clear when health plans receive their annual risk adjustment transfer payment reports from CMS each summer, and many are unhappy. The fact is that many health plans, busy serving their members by supporting quality care at a reasonable cost, simply don’t have the requisite resources or experience in place to complete the arduous tasks needed to comply with EDGE server data submissions. EDGE server requirements are challenging—and continue to evolve.

If you think there’s opportunity for improvement, now’s the time to consider a new direction for your 2017 benefit year submissions. Should you do it on your own? Stick with a vendor you’re not thrilled with? Before you decide, consider all the things that a proper EDGE server process should entail. Your solution should give you:

  • On-time, accurate submissions
  • Ongoing risk optimization services
  • Data management setup and continuous data management services
  • Analytic reporting
  • A support staff to keep up with HHS changes and respond to EDGE server updates
  • Peace of mind and the ability to focus internal resources on your day-to-day responsibilities

What Can Truven Do? Our Data Speaks for Itself.



If complying with CMS’s EDGE server requirements is taxing your organization’s resources, it’s time to consider partnering with a qualified EDGE server administrator, so you can get back to the business of offering quality health care. Contact us to learn more.

 

Bryan Briegel, Healthcare Reform Solutions Specialist 
Anita Nair-Hartman, Senior Vice President, Payer Strategy and Business Operations



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