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The Truven Health Blog


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


Big Data and Analytics: Getting Past the Hype to Real Value


By Anita Nair Hartman/Monday, March 24, 2014
Anita Nair-Hartman imageAs a health plan in today’s complex and challenging environment, it’s easy to get your head turned by promises of Big Data and new analytic techniques. After all, you’re facing an immediate need for information and analyses to successfully manage your business. Big Data must be the answer, right?

 The best answer is “maybe.” The new data sources and analytic techniques just might hold the answers you’ve been looking for. Then again, the answers you need might have been right in your backyard all along. The question is, How do you get past the “Big Data hype” to find the sound data sources and smart analytic methods that will help you meet your goals?

The bottom line is that unless you know how these new tools and techniques can help you make better decisions, they won’t be useful to you. Before you jump to the “next big thing,” be sure you’ve fully explored the value in the data you already have.

Anne Fisher image“Next Generation” healthcare analytics can help you make better decisions — but only if the new tools, techniques, and science are combined with good data and a deep understanding of the business environment. Properly leveraged, the most promising analytics will help you respond to today’s rapidly changing business environment and enable you to thrive under reform, control costs, engage your consumers, and make the best or your new provider relationships. Intelligent application is what matters.

Read our latest insights brief, Next Generation Analytics: Getting Past the Hype and Finding Real Value, for more details. Or email us to find out how we can help you meet your business challenges with smart data and analytics.

Anita Nair-Hartman, Vice President of Market Planning and Strategy
Anne Fischer, Director of Healthcare Analytics

Big Data and Analytics: Getting Past the Hype to Real Value


By Anita Nair Hartman/Monday, March 24, 2014
Anita Nair-Hartman imageAs a health plan in today’s complex and challenging environment, it’s easy to get your head turned by promises of Big Data and new analytic techniques. After all, you’re facing an immediate need for information and analyses to successfully manage your business. Big Data must be the answer, right?

 The best answer is “maybe.” The new data sources and analytic techniques just might hold the answers you’ve been looking for. Then again, the answers you need might have been right in your backyard all along. The question is, How do you get past the “Big Data hype” to find the sound data sources and smart analytic methods that will help you meet your goals?

The bottom line is that unless you know how these new tools and techniques can help you make better decisions, they won’t be useful to you. Before you jump to the “next big thing,” be sure you’ve fully explored the value in the data you already have.

Anne Fisher image“Next Generation” healthcare analytics can help you make better decisions — but only if the new tools, techniques, and science are combined with good data and a deep understanding of the business environment. Properly leveraged, the most promising analytics will help you respond to today’s rapidly changing business environment and enable you to thrive under reform, control costs, engage your consumers, and make the best or your new provider relationships. Intelligent application is what matters.

Read our latest insights brief, Next Generation Analytics: Getting Past the Hype and Finding Real Value, for more details. Or email us to find out how we can help you meet your business challenges with smart data and analytics.

Anita Nair-Hartman, Vice President of Market Planning and Strategy
Anne Fischer, Director of Healthcare Analytics

Health Information Exchanges Provide Valuable Information to ED Physicians


By Byron C. Scott/Wednesday, March 19, 2014
Byron Scott imageIf you polled every physician, especially emergency medicine physicians, in the country, and asked if it would be valuable to have access to patient data from Health Information Exchanges to help prevent unnecessary admissions from the Emergency Department (ED); the answer would be 100% yes. I applaud the study by Joshua Vest PhD at the Weill Cornell Medical College to continue the national debate and increase the awareness about the importance of health information exchanges to reduce costs and unnecessary care in the country. The state of New York and others have been on the forefront to invest in the exchanges.

I realize that many are afraid to allow access to health records across a large spectrum because of HIPAA concerns, but I can tell you that as an emergency medicine physician, it’s safer for the patient. Emergency medicine physicians are the gate keepers and the ultimate patient advocate. If you become a patient in the emergency department, your physician will need to access records and diagnostic test results to avoid performing repeat tests and creating unnecessary readmissions. Many times a patient cannot remember what was done, where it was done, or even the results of the test performed. Yet, the patient is brought to a hospital in the middle of the night by ambulance to a hospital in town they have not been to. Yet, they had a vital piece of information during another stay that could mean the difference in whether additional test or admissions are performed. Even in the age of electronic medical records and advanced technology, it’s still challenging to try to get information from an unaffiliated hospital, clinic, or doctor’s office.

I actually worked a 12-hour shift in the Emergency Department just last week. I saw a patient who suffered an injury but went to an Urgent Care facility just a few hours prior to seeing me in the Emergency Department. The patient had an x-ray at the unaffiliated clinic, and therefore I didn’t have access to this information. It was a diagnostic test I needed to visualize to make the correct treatment and disposition decision. Fortunately, the urgent care clinic made a copy of the x-ray on disc and gave it to the patient. Thankfully, he brought it with him, preventing me from ordering another x-ray, adding to the cost of his treatment, and exposing him to additional radiation exposure. I was lucky in this scenario, but countless physicians (me included) could tell you stories where if we had access to information quickly, we could not only reduce cost, but improve customer service to the patient. 

We must continue to educate and support the need to Health Information Exchanges to improve safety, reduce cost, and improve efficiency. This further buoys the conversation about Population Health and the continued need for integration of clinical and administrative data on a real time basis.

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

Are Your Employees Getting the Benefits You Think You’re Providing?


By Marie Bowker/Wednesday, March 12, 2014
Marie Bowker imageDespite the Patient Protection and Affordable Care Act (PPACA) mandate of 100%, pre-deductible coverage for many preventive services, your health plan or Pharmacy Benefit Manager (PBM) may be interpreting or implementing the plan differently. Or, you may think your plan is not paying for services like cosmetic procedures or non-emergency use of emergency departments; but it depends on your health plan’s system setup.

Either way, if your employees aren’t getting the benefits they were promised at enrollment, it can cause major problems for you.

Luckily, there is a solution — a comprehensive audit of 100% of your claims.

From our experience at Truven Health Analytics™, a comprehensive claims audit typically reveals that up to 8% of claims are paid incorrectly. These incorrect payments often point to breakdowns in plan implementation, but they can also crop up if there are other issues like:
  • coding errors
  • lack of quality control
  • administrator system setup issues
  • even, fraud and abuse
Truthfully, if you have any question about how your carrier is administering your plan, a comprehensive audit of 100% of claims is in order. How else will you know how your plan is being administered?

Putting your health claims under the microscope and really analyzing them is the only way you can be sure you are maximizing the financial performance of your healthcare benefit and providing all of the employee benefits you contracted to provide. Plus, ensuring your claims are paid accurately — and in compliance with your plan design — could save you millions of dollars.

Plan sponsors can read our latest insights brief, Three Reasons Your Employees Aren’t Getting the Benefits You Think You’re Providing, to get details about what to look for and how we can help.

Marie Bowker
Senior Director, Practice Leadership

Maternity Care the Ideal Setting for Evidence-Based Practice and PCP/Specialty Collaboration


By Michael R. Udwin/Monday, March 10, 2014
Michael R. Udwin imageThe recent Crain’s New York Business article “Birthing biz booms for hospitals,” captures the complex dynamic of balancing hospital service lines to support revenue, manage costs, and ensure the well-being of a community – in this case mothers and babies. Successfully managing these three objectives requires strong leadership and evolving business intelligence resources. As negotiated reimbursement rates shift from volume to value, it won’t be enough to merely focus on high-margin procedures. 

The best hospitals and health systems recognize the importance of integrating clinical pathways that invite evidence-based practice from both primary care and specialty providers. Maternity care is an ideal setting for such collaboration, since the stakes are so high. Rapid identification of high-risk mothers can not only ensure the health of the mother, but also the well-being of the newborn, with a reduced likelihood of needing to use neonatal intensive care resources.

Effective care coordination for any service line depends on timely, accurate and actionable data across the care continuum. Accomplished leaders leverage such intelligence to identify gaps in care, quality below expectations and costs attributable to inefficiencies. As negotiated reimbursement rates shrink, penalties for avoidable events expand and transparency to consumers evolves, healthcare data will be the medium by which we not just measure our achievements, but ensure the health and well-being of our collective mothers, babies, and families.

Michael R. Udwin, MD, FACOG
National Medical Director

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