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The Truven Health Blog


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


Exposing Business Leaders to the Benefits of Workplace Health Promotion Programs


By Ron Z. Goetzel/Tuesday, April 28, 2015


How do the best workplace health promotion programs create a healthy workforce and, ultimately, help the business be more competitive? What are best practices for workplace health promotion programs? Where can one find examples of successful workplace health promotion programs from both large and small employers?

These topics and more are the focus of Promoting Healthy Workplaces, a two-year research project conducted by the Institute for Health and Productivity Studies (IHPS) at Johns Hopkins University, with support from the Robert Wood Johnson Foundation. The project aims to define the ingredients necessary for establishing and maintaining excellent wellness programs.

After reviewing the existing literature, the IHPS team sat down with dozens of experts and then visited nine companies that actively promote the health and well-being of their workers - Turck Inc., Graco, Lincoln Industries, USAA, Dell, Citibank, Next Jump, LL Bean and Johnson & Johnson. Each firm is unique, yet all have incorporated a culture of health into their core values, and all have corporate leaders who believe that health promotion is the right thing to do for their employees and at the same time enhance business performance.

IHPS has dedicated a portion of its website to this initiative. There, employers will find a wealth of information and a blog that offer important insights and detailed examples of successful workplace health promotion programs – the “secret sauce” for program design, implementation, and evaluation. The program is expected to serve as a valuable resource for business leaders, human resources executives, corporate medical directors, and media interested in:

  • Reading stories that highlight the unique paths each best-practice company has taken in creating a healthy company culture for employees;
  • Finding out how employers measure “success” to underscore the value-on-investment (VOI); and
  • Learning how to use incentives most effectively to sustain employee engagement in a range of health improvement initiatives

In coming months, the website will feature more company profiles, videos, news about the latest peer-reviewed research, cogent interviews with industry leaders, and expert analysis of the ever-changing health promotion landscape. 

Ron Goetzel
Vice President, Health and Productivity Research


 


Appealing the CMS Risk Adjustment and Reinsurance Calculations: Making Sense of the Discrepancy Regulations


By Bryan Briegel/Friday, April 24, 2015


On March 16, the Centers for Medicare & Medicaid Services (CMS) issued a memorandum to all Edge server issuers, titled Technical Guidance for FORMAL Discrepancy Reporting Procedures Regarding Edge Server Outbound Risk Adjustment and Reinsurance Program Estimate Reports

This technical guidance reminded issuers that if they want to appeal CMS’s risk adjustment and reinsurance calculations, two windows are available to file a formal discrepancy. (A formal discrepancy is a required action to preserve the issuer’s rights to appeal these calculations.)

The first formal discrepancy reporting window allowed issuers to use either the Risk Adjustment & Reinsurance (RARI) reports that CMS triggered in March, 2015, or the RARI reports they triggered on April 3, 2015. This first formal discrepancy reporting window closed on April 14.

The second—and final—formal discrepancy reporting window for issuers who wish to preserve any calculation appeal rights opens on May 4th and closes 15 days later, on May 18th. Because this final formal window is extremely brief and the process is detailed and complex, issuers are naturally looking for a way to gain more time.

The compressed timeline, combined with CMS’s recent decision to trigger RARI reports weekly until April 30, has led to some confusion on which CMS reports may be used to support the second and final formal discrepancy process. Issuers now have so many CMS-triggered RARI reports and so little time that some are planning to use April-triggered reports, but the regulations dictate that the May reports must be used.

Truven Health Analytics encourages issuers to review CMS’s guidance, and ensure they use their May 1–3 CMS-generated RARI reports in any formal discrepancy process. In tandem, we have reached out CMS to ask them to consider publishing an FAQ reminding issuers that only this report may be used in the second and final discrepancy reporting process. To learn more about this issue or other Edge processes, contact us.

Brian Breigel
Director, Operations


Using Productivity, Absence, and Quality Measures to Drive Business Decisions


By John Azzolini/Thursday, April 23, 2015


Implementing an effective health and productivity management strategy is critical to creating a healthy, high-performing workforce and, ultimately, business competitiveness. Although employers have known for a long time that a healthy employee is more loyal and engaged, studies1 have also shown a direct relationship between employee health and profitability.

As employers take a more integrated view of the programs that touch on all of the aspects of employee health, well-being and productivity, they are realizing the importance of having benchmarks that are similarly comprehensive. Unfortunately, such broad benchmarks have been difficult or expensive to come by. This issue was an impetus behind the creation of EMPAQ® (Employer Measures of Productivity, Absence and Quality™).

EMPAQ is an online survey-based measurement tool, developed by employers for employers, that helps quantify the costs of poor health, low productivity, and absence. The goal is to assist companies with health and productivity program evaluation by comparing their experience to benchmarks of peer performance based upon a set of key metrics in four categories:

  • Overall absence
  • Non-occupational absence
  • Occupational absence
  • Group health and employee assistance programs 

EMPAQ was originally created by the National Business Group on Health in 2001 and after a 5-year hiatus was re-launched this year in conjunction with Truven Health. Employers who submit their data between April 2 and May 29, 2015 will receive an individualized benchmark report for the 30 key EMPAQ metrics. Results will also be pooled across survey participants to create EMPAQ-wide benchmarks and a national report which will be released to the general public.

In short, the EMPAQ initiative should provide much needed benchmarks for the important work of keeping employees, healthy and productive. For more information, visit http://www.empaq.org/.

John Azzolini
Sr. Director, Practice Leadership


1 Loeppke RR, Taitel M, Haufle V, Parry T, Kessler R and Jinnett K. Health and productivity as a business strategy: A multiemployer study, J Occup Environ Med. 2009; 51:411-428.
Loeppke RR, Taitel M, Richling DE, et al. Health and productivity as a business strategy. J Occup Environ Med. 2007;49: 712–721.
Edington DW, Burton WN. Health and Productivity. A Practical Approach to Occupational and Environmental Medicine. Philadelphia: Lippincott Williams & Wilkins; 2003:140 –152.


Inpatient Medical Care Transitions


By Michael L. Taylor/Monday, April 20, 2015

One of the architects of the Affordable Care Act, Ezekiel Emanuel, has famously said, “We don’t need 5000 hospitals.” For several years, the number of inpatient admissions has been declining, and that trend is not likely to change. According to the American Hospital Association, 27 hospitals permanently closed their doors in 2014. Inpatient days have declined by 5% over a recent 4 year period, and the US hospital occupancy rate is down to 60%. There are myriad reasons for this decline, including the shift to outpatient centers for many procedures, fewer elective surgeries, declining length of stay, and more patient awareness of other options.

Other factors include the readmission penalties instituted by CMS, the increase in “observation” stays, and the growth of high deductible health plans with the resulting shift of costs to employees.  A newer driver of the fall in hospital days and services utilization is the move from Fee for Service (FFS) to more shared risk/reward strategies. As Accountable Care Organizations (ACOs) and similar arrangements become larger and more prevalent, hospitals will see payment reform impacting all lines of services. Under the FFS form of payment, high tech services were revenue generators, and hospitals were incented to build more MRIs and cardiac catheterization labs. Due to payment reforms, these services now are cost centers, and hospitals are urgently seeking new ways to manage their costs. 

Many communities across the country have an excess number of beds given the falling demand, so hospitals will find other uses for these extra beds – or close them.  Shedding unneeded capacity should help hospitals run more efficiently and decrease redundancies in many markets. Hospitals can use data to decide how many services are needed, and can build facilities based on need, rather than as a revenue driver. Hospitals need more data to understand the market they serve, to analyze the efficiency of the services they provide and the quality of the service lines they do keep.

An article in the Archives of Internal Medicine looked at non-emergency cardiac stent placement. In this report two cardiologists reviewed the records of 7000 patients who had stents placed as part of 8 different clinical trials. That analysis suggested nearly 2/3 of the stents placed were not needed – which is both a cost and a quality issue. A Truven Health analysis found nearly 30% of the medical spend in the US was unnecessary. Payment reform under the Affordable Care Act is designed to lessen the burden of unneeded care, and as the healthcare delivery system becomes more efficient, the need for hospitals will continue to decline. As hospitals become more efficient, driving out waste and improving quality, we may see the cost curve stabilize and even “bend” in the right direction. 

Michael L. Taylor, MD, FACP
Chief Medical Officer



Emergency Department Physicians Ordering Unnecessary Imaging Tests


By Byron C. Scott/Thursday, April 16, 2015


As a residency trained, board certified emergency medicine physician who practiced for over 20 years, I was not surprised entirely by a recent Health Leaders’ article stating that ED physicians order unnecessary imaging tests, based on a research article published in Academic Emergency Medicine in April of 2015.    

There is no question that as a practicing physician in the emergency department, you try to make decisions based on sound evidence-based medicine.  The reality is that other factors are constantly influencing decisions, such as patient demands, other physicians involved in a case, liability issues, and just not wanting to miss something that could harm the patient.  On multiple occasions during my career as a medical director and practicing emergency department physician, I have seen patients with a history and physical exam that did not justify ordering an additional imaging test,  however, medicine is an art and often instinct plays into decisions.  If emergency department physicians ordered tests based exclusively on what evidence based medicine supports, many emergent diagnoses would be missed causing a poor outcome for the patient.  The assumption is that not ordering a test because the evidence does not support it will protect you in a malpractice lawsuit.  However, those who have practiced medicine for years know this is not always the case.  

The best approach for now is to continue to look at innovative ways to engage patients and physicians.  For physicians, this will include having real-time prompts and reminders tied into the electronic medical record ordering system, based on evidence based guidelines that are easy to use and access.  Today, patient education and engagement tools are mostly used outside an acute emergency department, but perhaps these tools with their easy-to-use clinical information, statistics, and images could also provide real-time education for the patient to help explain why certain imaging tests are not required.   Tort reform may be one way to influence excessive ordering of diagnostics test but I believe the clinical instinct and art of medicine, as well as evidence based guidelines and patient education, are important to achieving the best outcomes.

Byron C. Scott, MD, MBA, FACEP, FACPE
Medical Director, National Clinical Medical Leader

 


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