The Truven Health Blog

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

Specialty Pharmacy Trends for Employers

By Truven Staff/Friday, April 29, 2016

The pharmacy benefit landscape today is complex and rapidly changing. This infographic leverages data from our MarketScan Research Databases to give an overview of how the marketplace has changed from 2014 to 2015. Find out more here. 

Want to learn more about specialty pharmaceuticals? Read our blog or contact us at payersolutions@truvenhealth.com

A Closer Look at Post-Acute Care Variation for Total Joint Replacements

By Bob Kelley /Wednesday, April 20, 2016


At Truven Health AnalyticsTM we’ve been researching cost variation in simulated bundled payments for privately insured total joint replacement (TJR) patients for several months now. (Visit the landing page for more information and recently released briefs.)

In an earlier blog post, we reported that cost differences across U.S. Census regions for the post-acute care portion of a bundle ranged from an average of $3,907 to $5,292.


I’d like to make a few additional points about these differences.

First, there is no apparent link between hospitalization cost and post-acute care cost.

We know from our previous research that anchor hospitalization costs were the main driver of the variation in overall bundle cost. Post-care services were the next most impactful driver. But we’ve found no clear relationship between the average post-acute care cost in a division and the average anchor cost.

The highest cost variation was found in rehabilitation facility costs.

Our study found substantial differences across divisions in the average cost by type of post-acute care service a patient received. For home healthcare costs, the difference in the average cost per patient was just $1,300. For skilled nursing facility care, the difference was more than $5,000. And for care at an inpatient rehabilitation facility, the difference was more than $10,500 per patient.

This information definitely points to the importance of discharging a patient to the right care option to keep costs down, while still providing the best care and achieving the best outcomes.

 Of course, regional preferences play a role.

Because of our study’s large sample size, it is unlikely that post-acute cost variations result from differences in patient characteristics. However, simple geographic-area preferences — such as historical patterns, post-acute care facility availability, or health plan contract rules and payment rates — could play a role. More research would be needed to identify those patterns.

You can read more about our findings by downloading the full research brief, Bundled Pricing for Total Joint Replacements in the Commercially Insured Population: Cost Variation Insights by Bundled Care Components.

Stay tuned for a new brief coming soon on the role of readmissions in TJR bundled costs.

Bob Kelley
Senior Research Fellow, Advanced Analytics

Help Employees Choose the Best Benefit Plan

By Truven Staff/Tuesday, April 19, 2016

Did you know that 73 percent of employees select the same benefit plan each year -- and 42 percent waste up to $750 per year because of benefit mistakes1?

With more benefit choices and challenges than ever, employees need help choosing the right benefit plan for their situation. But they need more than plan information and premium costs – they need a mentor.

Interested in learning more? Download this solution sheet, or contact us at payersolutions@truvenhealth.com for more information and/or to view a demo.

1.     Aflac Open Enrollment Study

Understanding Your Exchange Population: Answering the Questions

By Kimberly Bradbury/Thursday, April 7, 2016

According to a recent article in the Wall Street Journal, health plans are now seeking substantial rate boosts and citing higher than expected medical costs incurred by people newly enrolled under the Affordable Care Act, making exchanges a viable part of the healthcare blueprint. To better understand exchange populations, Truven Health Analytics teamed up with a large health plan to investigate the demographics, risks, finances, and utilization patterns of the exchange population in the health plan’s state.  As discussed at AHIP Institute last week and covered in a Modern Healthcare article, we found:

  • Exchange enrollees are significant consumers – with 64% more emergency room visits and 39% more admissions than non-exchange members
  • Exchange enrollees may be older than expected
  • Exchange enrollees have a higher prevalence of heart failure and diabetes
  • Exchange enrollees specialty drug costs are higher

Although we found a lot of data that contradicted the pre-exchange enrollment forecasts, one conclusion can be drawn from our analysis: It’s more important than ever to understand the details about your unique populations to create appropriate product strategies and plan designs for the future.

In addition to the questions we highlighted in our previous blog, Understanding Your Exchange Population: Are You Asking the Right Questions?, there are also specific actions you can take to ensure your care management programs, member services and outreach are tailored to your exchange members’ unique needs:

  • Leverage clinical data from your first-year ACA plan members’ cost, utilization and demographics, and couple it with advanced analytic tools
  • Understand your population to determine the behaviors that guide their healthcare consumption
  • Risk stratify members to identify opportunities for intervention
  • Include accurate coding initiatives to optimize members’ risk scores that will drive risk fund transfers and plan profitability

Taking these actions is vital to the success of your plan, but it’s a task that requires advanced analytic skills and methodologies. With more than 30 years experience, Truven Health can use your exchange data to help you perform the actions necessary for implementing product strategies and plan designs that are tailored for your members. 

To learn more, download the research brief and register for our upcoming AHIP webinar, Understanding Your Exchange Population: Lessons from Real-Life Data

Kimberly Bradbury, Senior Analytic Consultant
Kevin Ruane, Director of Client Services