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The Truven Health Blog


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


Are Employees Utilizing Your Employee Assistance Programs?


By Truven Staff/Thursday, February 25, 2016

Employee Assistance Programs (EAPs) are beneficial for employees with personal problems that impact their job performance, health and well-being. However, many employers have a difficult time getting employees to utilize these programs.

Truven Health Analytics and National Business Group on Health partnered to conduct a study to determine the financial investment employers have made in EAPs, as well as how much of their population they’re reaching.

EMPAQ tracked two critical metrics related to Employee Assistance Programs (EAPS) – average program costs and cases per 100 employees in a given year.  In doing the research, we found that:

  • Program costs averaged $22 per employee, with the highest spending in the energy and utilities industry and the lowest in healthcare.
  • EAP participation averaged 6 cases per 100 employees. The highest participation was in the hospitality and retail sector; the lowest rate was in pharmaceuticals.
Using EMPAQ Data to Help Employee Satisfaction

Having access to data on the management of absence, health, and productivity programs is beneficial, but only if it’s used to improve the company. To increase employee participation in EAPs:

  • Look for creative ways to communicate the value of EAPs to employees. Year-round communications are more likely to remind employees of the valuable service at the time they need it.
  • Use senior leadership and managers to advocate the value of EAP. Support from management has been shown to increase the program’s utilization because they help to destigmatize the use of EAPs.
  • Consider offering on-site EAP counseling. On-site counselors can develop a rapport with employees to ensure they get the care they need – whether counseling or other benefit program the company offers.

EMPAQ provides employers with a framework by which to measure and monitor the return on investment they’re receiving from their 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 EAPs programs, and six key health and productivity programs. Organizations that participate in the survey process receive a customized benchmarking report. Download a sample customized report.


Makeup of TJR Bundled Costs in Commercially Insured Differs From Medicare Population Bundles


By Bob Kelley /Thursday, February 25, 2016

As part of the Truven Health AnalyticsTM continuing research series into total joint replacement (TJR) bundled costs for commercially insured patients (age 45 to 64), we’ve found that readmissions make up a small percentage of average total bundled costs — 2.1 percent (just $760 on average per patient). That appears to be true no matter what region of the U.S. patients are located.

The average percentage of total bundled costs due to post-acute care is also fairly low, although higher than readmissions, at 12.7 percent. The average percentage among U.S. Census divisions ranges from 10.8 percent (Mountain Division) to 14.5 percent (East South Central), which shows a bit more cost variability than readmissions.

 

Our simulated commercial bundles included inpatient hospitalization, post-acute care, and readmission costs.

 

Here’s a very quick look at what we found:

These findings are in contrast to projections for Medicare’s older population. For example, additional Truven Health analysis of simulated TJR bundles for one large hospital showed that 21 percent of the Medicare total bundled cost was for post-acute care compared to less than 8 percent in the commercially insured bundles — with almost 14 percent versus 4 percent for skilled nursing facility costs alone.

 

Of course, it’s not unexpected that an older, 65+ Medicare population would have a higher likelihood of serious comorbid conditions and a greater need for post-surgical support. However, the Centers for Medicare & Medicaid Services predict that most of the cost-savings for the Medicare population and its new Comprehensive Care for Joint Replacement (CJR) Model will originate from improvements in post-acute care and readmissions costs after reducing cost variation through bundling.

 

The savings opportunities appear to be far less obvious in the commercial population.

 

For more details on our data, methodology, and other findings, you can download the complete research brief, Bundled Pricing for Total Joint Replacements (TJRs) in the Commercially Insured Population: Geographic Variation and Cost-Driver Insights.

 

Our next brief will cover an analysis of the impact of length of stay and post-acute care decisions on bundled commercial costs for TJR patients. If you’d like to be alerted via email when that brief is released, you can provide us with your information via interest.truvenhealth.com/BundledPaymentsWP.

Bob Kelley
Senior Research Fellow, Advanced Analytics

 

 

 


How Are Your Administrators Complying With the ACA Maximum Out-of-Pocket Limits that Started January 1?


By Marie Bowker/Tuesday, February 23, 2016

According to a recent article in Modern Healthcare, beginning in 2016, the Affordable Care Act (ACA) limits how much people have to pay out of pocket for deductibles, coinsurance and copayments across all benefit types. The maximum yearly amount is $6,850 for individuals, and $13,700 for families.

This new requirement means that your medical, mental health, and prescription drug administrators have to start sharing data to ensure your plan members don’t pay more than the maximum out-of-pocket limit across all benefit types combined. 

It’s Complicated, but Doesn’t Have to Be.

Truven Health Analytics research finds that cross-administrator integration often isn’t implemented properly. Ensure your administrators are meeting the above, and other complex requirements, with a 100 percent, post-implementation audit approximately 90 days after the date of your material change. This analysis should:

  • Re-adjudicate all claims for compliance with plan designs
  • Validate eligibility and compliance with your administrator’s policies and procedures
  • Incorporate industry best practices
  • Flag areas where you’re not, or are at risk of not, meeting ACA regulations

If you’ve recently made plan design or administrator changes, download these case studies to explore what our audits uncovered for some clients – and could uncover for you.

Marie Bowker
Senior Director, Payment Integrity


IBM Watson Health and Truven Health Analytics: Joining forces to improve health outcomes and advance value-based care solutions


By Mike Boswood/Thursday, February 18, 2016

Today, IBM announced its plan to acquire Truven Health. Once the acquisition closes, Truven Health will help IBM continue to build an unparalleled array of healthcare capabilities to help improve health outcomes, control costs, and advance value-based care.

Upon completion of the acquisition, IBM’s health cloud will house one of the world’s largest and most diverse collections of health-related data and the ability to apply cognitive tools to obtain previously unavailable insights. Additionally, IBM is well positioned to scale globally and to build leading-edge solutions designed to help clients succeed in a value-based care environment.

The Truven Health team looks forward to combining our expertise with Watson Health. Why? Because it can catapult the industry forward to transform healthcare and improve lives.

You can find more information here. I look forward to working with Watson Health to deliver more value to our customers and ultimately, to patients. 

Mike Boswood
President & CEO


New Regional Data Research: More Than $10,000 Difference in Commercial Bundled Costs for Total Joint Replacement


By Bob Kelley /Wednesday, February 17, 2016

 

While much data has been released by the Centers for Medicare and Medicaid Services (CMS) on how total joint replacement (TJR) bundled costs differ regionally for Medicare patients, data on commercial bundles has been more limited.

But as private insurers, in addition to government payers, apply bundled payment policies to their contract negotiations, commercial data and analysis become increasingly important as both providers and payers prepare for the trend.

In the new Truven Health AnalyticsTM research brief, Bundled Pricing for Total Joint Replacements (TJRs) in the Commercially Insured Population: Geographic Variation and Cost-Driver Insights, we’ve tackled the subject with simulated bundled pricing based on our proprietary commercial claims database and the nine U.S. Census divisions. Our bundles included inpatient hospitalization, post-acute care, and readmission costs.

The study found there is a nearly 30-percent variation in commercial-patient TJR bundled costs across census divisions, from nearly $30,000 per patient to more than $40,000.

Specifically, our analysis showed that the average TJR bundled cost in the commercial population ranged from $29,825 in the East South Central division to $40,431 in the Middle Atlantic — a difference of more than $10,500 per patient.

It is not surprising that this geographic variation research raised significantly more questions about why cost variation exists. We will be addressing those additional questions about cost-drivers, length-of-stay impact, and more in coming research briefs in this series and in future blog posts. You can download the first brief here.

In addition, if you’d like to be alerted via email when additional commercial bundled pricing research is released, please provide us with your information via http://truvenhealth.com/issues/bundled-payments.

Bob Kelley

Senior Research Fellow, Advanced Analytics

 


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