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The Truven Health Blog


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


Four Reasons to Visit Truven Health at HRE


By Truven Staff/Monday, March 28, 2016

 

Employers throughout the country are gearing up to attend the 2016 HRE Health and Benefits Leadership Conference Wednesday, March 30 and Thursday, March 31. The conference is one of the nation’s most innovative health & benefits expo's for employers -- and Truven Health will be there to discuss our solutions and ideas to help you enhance your benefit program.

Here are a few reasons to stop by booth #220 to talk to representatives from Truven Health:

1. Increase your odds to win big in Vegas - Enter to win $100 of Aria casino chips.

2. Learn how we can put your data to work to:

●      Control costs

●      Improve health

●      Engage employees

3. Gain knowledge on Truven Health solutions, such as myBenefits Mentor, Interactive Reporting, and Payment Integrity.

4. Get a personal tour of our mid-size employer webpage - Stop by our booth to get a sneak peek at our new webpage that was created specifically to educate mid-size employers on how our solutions can help you and your employees.

Truven Health will be at booth #220 Wednesday, March 30 and Thursday, March 31. View the full schedule for HRE Health and Benefits Leadership Conference here



Five Ways to Manage Specialty Pharmacy Spending


By Ryan Peterson/Wednesday, March 23, 2016

The pharmacy benefit landscape today is complex and rapidly changing. Pharmacy Benefit Manager (PBM) mergers and acquisitions, new ACA mandates, and a number of other factors are leading to price uncertainty for PBMs, health plans, and employers alike. But one of the most significant drivers of pharmacy cost increases is the continued introduction of new specialty drugs into the marketplace, with a projected growth rate of 17 percent

Worrisome trends, such as patent exclusivity, lack of high-quality alternatives, adding indications, evergreening, lack of price regulation, and increased prices, are making it even more critical for employers and health plans to better understand their specialty drug spend — and find ways to combat the cost.

Fortunately, there’s a multi-step approach that will put any health plan or employer on the path to  better specialty pharmacy management without compromising the quality of care:


Specialty Pharmacy Analysis in Action

One large U.S. employer recognized that its specialty drug expense was expected to increase from $23 million in 2013 to more than $40 million in 2016 — requiring swift action to get costs under control. After conducting a multi-step analysis with Truven Health Analytics, the client is implementing several cost-saving strategies, including increasing the coordination of benefits with medical and pharmacy benefit vendors, directing services to best-cost locations, and reviewing covered drugs and therapeutic value, which could result in total savings of approximately $1.9 million.

Want to find out how you can save on specialty pharmaceuticals? Download our infographic or contact us at payersolutions@truvenhealth.com,

Ryan Peterson
Director of Analytic Consulting

 

1.       2014 Insights Report. CVS Health, Fall 2014. Web. <http://www.cvshealth.com/2014-insights-report-specialty-drives-trend>.


Are You Happy With Your EDGE Server Data Submission Process?


By Truven Staff/Monday, March 21, 2016



With the May 2 CMS deadline for submitting your 2015 benefit year data to the EDGE server just six weeks away, it’s a great time to ask yourself: Are we feeling confident and prepared? Will our organization’s approach work for another year?

We think a few key questions to ask are:

  •  How well is our approach to EDGE working?
  • Did we have clean data to optimize our risk adjustment efforts?
  • Were we able to respond to the constant change in CMS requirements effectively?
  • What improvements do we need to make?

  • The difficulties in optimizing risk and processing EDGE data effectively became abundantly clear when health plans received their risk adjustment transfer payment report from CMS last June – and many were unhappy. The fact is, many health plans — busy serving their members by providing quality care at a reasonable cost — simply don’t have the proper resources or experience in place to complete the arduous tasks needed to comply with the Premium Stabilization Programs. The EDGE server requirements are challenging — and they will continue to evolve.

If you think there’s opportunity for improvement, now’s the time to consider a new plan of for your 2016 submissions. Should you do it on your own? Before you decide, consider all the things that a proper EDGE server process should entail. Your solution should give you:


  • On-time, accurate submissions
  • Ongoing risk score optimization services
  • Data management setup and continuous data management services
  • At a minimum, quarterly analytic reporting
  • A support staff to keep up with HHS changes and respond to their EDGE server inquiries
  • Peace of mind and the ability to focus internal resources attending to your day-to-day responsibilities

 

What Can Truven Do? Our Data Speaks for Itself.


If complying with CMS’s EDGE server requirements is taxing your organization’s resources, it’s time to consider partnering with a qualified EDGE server administrator, so you can get back to the business of offering quality health care. Contact us to learn more.

 

Bryan Briegel, Healthcare Reform Solutions Specialist 
Anita Nair-Hartman, Senior Vice President, Payer Strategy and Business Operations



Program Evaluation Tips - Disease Management and Wellness


By Truven Staff/Thursday, March 10, 2016

The healthcare industry is changing ― reform and government mandates are calling for improved access and quality of care, the need for consumer engagement is increasing, and costs are rising.  With all these changes, employer human resources professionals are being held more accountable by their C-suite to prove the value of every dollar being spent on wellness or disease management programs ― and employers are holding health plans more accountable for their disease management programs.

Best Practices for Program Evaluation

Past program evaluations lacked statistical rigor as they simply looked at trends in data over time. Not only was it unclear whether the trends were directly linked to the implementation of the program, but the evaluations also failed to take into account other events that might impact trends, such as turnover and benefit plan design changes.

As data and analytics experts, Truven Health Analytics professionals have evaluated a number of disease management and wellness programs for health plans and employers, using a methodology that is practical, reliable, and credible. Unlike previous approaches, the Truven Health best-practice approach adjusts for variables that affect analysis results. The solution has three key objectives:

  1. Understanding participation ― To understand whether there are opportunities to engage additional candidates, employers and health plans must first determine program specifications, including how different types of participation might be defined.

  2. Evaluating participation outcomes ― The objective of this step is to answer the question: What is the impact on clinical outcomes for program participants? Metrics for the evaluation of participation outcomes should be tied to evidence-based condition guidelines because they provide a detailed look at how the program is impacting these individual metrics.

  3. Determining financial impact ― Determining the program’s cost impact for all eligible participants is a vital step in program evaluation. Our best-practice approach to measuring program financial impact uses an econometric study design to measure the differences between the treatment and control groups over time. This method is intended to help eliminate the effect of selection bias.

See Program Evaluation in Action

Reliable program evaluation can be exactly what health plans and employers need today to educate and inform senior management, and to provide their stakeholders with insights that enable them to make their best decisions in a complex healthcare world. See the Truven Health best-practice approach in action.

Contact us for more information.

Christine Turner
Senior Client Executive

 


Joint Replacement Post-Acute Care and Readmissions: Variations Represent Opportunity to Improve Bundled Cost


By Bob Kelley /Thursday, March 3, 2016

In our continuing research at Truven Health AnalyticsTM into bundled payments for commercially-insured total joint replacement (TJR) patients, we’ve uncovered some additional insights this month. The research is based on simulated bundles that include the entire episode of care from surgery through 90 days post-discharge; the data is from the Truven Health MarketScan® commercial claims database, analyzed across U.S. Census divisions.

Length-of-Stay Finding

We found significant variation in the effect of anchor hospitalization length of stay on total bundled costs. The average impact varied from $313 per additional day in the anchor facility (after initial day of hospitalization) or 1 percent of the base price in the East North Central division, to $1,944 or 6.2 percent of the base price in the Pacific division.

 

Post-Acute Care Impact

We also found differences in average bundled cost across regions for post-acute care services, from $3,907 to $5,292 — a difference of nearly $1,400. In addition, the study identified significant variation in the average bundled cost by type of post-acute care received by patients (for instance, home health services versus a skilled nursing facility). The highest average patient cost was for care at a rehabilitation facility — the option that also had the greatest variability in cost across divisions.

And About Those Readmission Rates …

We also found that patients with multiple types of post-acute care had higher readmission rates. The combinations of rehab facility and home health, and skilled nursing and rehab, had similar readmission rates at 10.5 percent and 9.2 percent, respectively. What’s not known is whether these patients were at higher risk of readmission prior to discharge, or if the risk increased during post-acute care. We hope to tackle that question in future research.

So What’s the Key Takeaway?

All of this analysis points to the importance of discharge planning and directing patients to the appropriate care option when the goal is to reduce bundled costs for TJR, while maintaining high levels of quality and patient outcomes. While costs associated with post-acute care and readmissions were only a fraction of the total bundled costs for the commercial population, they were subject to substantial variability — representing perhaps an important opportunity to better manage results.

 

For more insights from this study, you can download the new research brief, Bundled Pricing for Total Joint Replacements in the Commercially Insured Population: Cost Variation Insights by Bundled Care Components, here.

 

Bob Kelley
Senior Research Fellow
Advanced Analytics

 

 


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