The Truven Health Blog

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

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 empaq@truvenhealth.com or visit empaq.org.

  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 http://www.jhsph.edu

By Ron Z. Goetzel/Thursday, October 1, 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