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The Truven Health Blog


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


Lean: Empowering Employees, Eliminating Waste


By Truven Staff/Monday, November 30, 2015

Patty Gabow, MD, had first-hand experience implementing Lean at a hospital as the CEO of Denver Health. In an HFMA article, she says one of her biggest take-aways is that you have to set an audacious, inspiring goal for Lean transformation  at Denver Health, it was to become a model for the nation. Mortality rate was a key metric for Denver Health, and while doing Lean their observed mortality rate was below the expected mortality rate for the kinds of patients they saw.

According to Dr. Gabow, "the core philosophy of Lean is that transformation is built on two pillars: respect for people and continuous improvement." Lean works to remove waste as viewed from the customer perspective, and does this with respect for the customer and for employees. "Many people who work in health care today feel unempowered, and Lean is both empowering and democratizing: It relies on the people who actually do the work to solve the problem." The importance of Lean's respect for people  came home to Dr. Gabow when she realized that "Lean returns joy to the work, which is something a lot of people in health care don't feel anymore."

See more of Dr. Gabow's comments at http://www.hfma.org/Leadership/Archives/2015/Fall/What_Lean_Can_Mean_to_Your_Organization%E2%80%94If_It_s_Done_Right/#sthash.PXIxFd2i.G19u79jB.dpuf

 

 


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 EMPAQ.org. 

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 2, 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.

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