The Truven Health Blog

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

Health Plans: Take Consumer Engagement Into Account When Planning For Insurance Exchanges

By Anita Nair Hartman/Thursday, April 25, 2013
Anita Nair-Hartman imageAdditional funding from HHS will support states continuing their efforts to build out their insurance exchange infrastructure.  For health plans, state- and federal-sponsored insurance exchanges represent a strong opportunity to attract and acquire new members. 

As a health plan, you carefully evaluate your public and private insurance exchange strategies relative to market opportunity, mandated coverage and plan design provisions, profitability, and other factors. But how much time do you devote to the user experience? Consumer user experience will play a large role in member retention over the next year. 

Currently, much focus in the market is on member attraction and growth relative to products, plan design, branding, and marketing. But it’s equally important to ensure that once you get a consumer via an exchange channel relationship, your health plan is well positioned to gain their loyalty and retain them. As you create your strategies, be sure to include consumer engagement. This process should start with the health plan selection process on the exchange.  You should choose to participate in public or private exchanges that offer a robust plan selection tool – one that’s user friendly and provides enough information to the consumer to clearly differentiate your products and brands.

Additionally, once you’ve acquired new members, it’s very important to offer them robust tools and services to better understand and manage their health.  Ensuring that your exchange strategy not only attracts members — but also retains them — will go a long way toward supporting your overall strategy.

Anita Nair-Hartman
Vice President Market Planning and Strategy

Least Cost Site of Care Takes Coordination & Reflection

By Linda MacCracken/Thursday, April 18, 2013
Linda MacCracken imageReducing cost while preserving effective care requires real-time coordination and analytic reflection – and as the healthcare system changes, the need for both is becoming ever more apparent. Walgreen’s announcement of retail healthcare services for the chronically ill opens a discussion of the impact of new innovation.  
Truven Health research shows over $4b savings potential when 20% of the ED visits are redirected to other sites, and 63% of ED visits are urgent but not emergent, there is room for change.  This journey is not new; nearly 5 years ago, 73% of national ED visits were urgent (not emergent).  Between more time conscious consumers, the rise of market driven urgent care centers and hospitals placing new walk-in programs on campus – the needle has moved. Shifting care from the most expensive resource calls for consumer driven self assessment and provider recommendation. 
Based on our 2012 consumer studies, 89% of retail service users are not replacing their primary care provider, as they report having one.  They are supplementing the services offered by their PCP, and generally for a lower cost. We see there is room and demand less costly care, but we recognize that this calls for coordination at the point of care, and reflectively and realistically reviewing the rearview mirror in consolidated datastreams.  One of our clients moved $1.5M of business to lower cost settings, just by direct messaging to frequent fliers to save their funds and go to another source.  Consumers hearing the trusted provider voice can take action on coordination.  Providers knowing the truth of analytic reflection can take action to ‘prescribe’ right site of care for the right reason.  And our healthcare system will be the better for coordination, cost and care.

Linda MacCracken
Vice President

Hooray for CMS, Agreeing to Reconsider a Longstanding Program!

By Jean Chenoweth/Tuesday, April 16, 2013
Jean Chenoweth imageAfter restricting Medicare payment for bariatric surgery to only Medicare approved centers of excellence for seven years, CMS has agreed to reassess its policy. That does not mean that the policy will be adjusted to broaden access to the procedure, but at least CMS will review the previous decision. That reflects a lot of flexibility for a government agency.

What is the cause for the policy reassessment? Results of research by Justin B. Dimick, M.D., Director of Policy Research at the University of Michigan’s Center for Health Care Outcomes and Policy, demonstrated that the Medicare policy made no difference, except to limit access to the procedure. The policy did not drive improvement. The policy did not improve complication rates or outcomes.

Almost everybody thinks development of Centers of Excellence is a great idea – including me! But I must admit that I am chastened by this example. Dr. Dimick allows the data to speak , which we do routinely within the 100 Top research group. Objective data often produces results that are contrary to what seems logical. Dr. Dimick’s results suggest a very uncomfortable idea. Maybe CMS’s channeling of patients to Centers of Excellence is a misguided good idea. Maybe a Center of Excellence makes people feel safer, but might cost them more out of pocket or cause them to seek no care. 

Let’s contrast this approach with the other side of the government coin, the National Cancer Institute, which is unrelated to payment for care. The National Cancer Institute created the National Cancer Information Service (NCIS) because of the huge disparity in physician and patient access to the latest treatments for various types of cancer. The NCIS enables cancer patients to directly call 800-4-CANCER to find out about new diagnostics and treatments as well as clinical trials so that the best possible options are known to all. Maybe the NCIS model which makes vetted, trustworthy diagnostic, treatment and clinical trial information available as widely as possible is a better approach. The NCIS model increases patient knowledge and patient involvement in decision-making. That may be a better approach than CMS deciding for us.

Jean Chenoweth
Senior Vice President, Performance Improvement and 100 Top Hospi

Helping Consumers Navigate Insurance Exchanges

By Anita Nair Hartman/Thursday, April 11, 2013
Anita Nair-Hartman imageA recent Kaiser Health News article questions consumers’ ability to navigate insurance exchanges. State-sponsored and federally facilitated insurance exchanges are building their technology platforms, selecting qualified health plans, and setting up their infrastructure. The underlying assumption is that in October 2013, when open enrollment begins, consumers will be prepared.  

The consumer’s ability to navigate exchanges is perhaps the most critical component of success. The Federal Government, recognizing that this process might confuse consumers, has funded Exchange Navigators to help consumers understand eligibility, subsidies, enrollment rules and processes, and the specifics of Qualified Health Plan (QHP) design provisions. 

Consumers and Navigators need robust information and efficient tools to manage this process. Improved consumer education benefits not only the consumer and the exchange but also the health plans — by ensuring that individuals select the plan that’s right for their situation and have a great customer experience while doing so. Increasing a consumer’s ongoing engagement in their own healthcare management can lower costs and increase their plan loyalty and satisfaction — which is especially important in this new marketplace. 

For exchanges to succeed, we must elevate consumer interest and participation in healthcare decision making to the same level as other important life decisions. States, the Federal Government, and health plans all need to share the responsibility to make that happen.

Anita Nair-Hartman
Vice President

Hospitals Need Analytics to Focus Interventions, Prevent Readmissions

By Michael R. Udwin/Friday, April 5, 2013
Michael R. Udwin imageAs suggested in the New York Times article of March 29th, hospitals are confronting expanded readmissions penalties without clear direction on which interventions are likely to yield the greatest impact relative to their unique circumstances. To paraphrase Occam’s Razor, often the simplest explanation is best.

How does this apply to readmissions? Over the years, Truven Health has helped its CareDiscovery customers connect the dots; linking patient populations across the spectrum of care from outpatient setting to hospital to post-discharge facility, and testing the impact of both process and practice on outcome. By following the patient path through risk-adjusted models, we can test and quantify the results of competing readmission theories.

As you might expect, it is often the simplest theory that prevails. Of course, such analytics not only validate the theory but serve to identify the drivers behind the higher than expected readmissions. Only at this point can one be assured that the application of evidence-based protocols can optimally address the highlighted opportunity. With diminished reimbursements and expanded disease burden, now more than ever hospitals must harness true and proven analytics to ensure a thriving population and future.  

Michael R Udwin, MD, FACOG
Medical Director