The Truven Health Blog

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

Understanding Your Exchange Population: Are You Asking the Right Questions?

By Kevin Ruane/Tuesday, May 26, 2015


Before the ACA, most health plan leaders had a solid understanding of the demographics, chronic conditions, and health risks of their members. The advent of exchanges has changed the landscape, however, and now more than ever, you need to understand the details about your unique populations to create appropriate product strategies and plan designs for the future.

Truven Health Analytics partnered with a large health plan to investigate the demographics, risks, financial patterns, and utilization patterns of its exchange population. Pre-exchange enrollment forecasts suggested that exchanges would attract younger people, offsetting the higher utilization and costs incurred by the older population. But our research of this health plan’s population revealed older exchange enrollees – 46 years old, on average, compared with 44 for the average off-exchange enrollee – and that the exchange enrollees had more hospital admissions and emergency department visits, and were more susceptible to costly chronic conditions, specifically heart failure and diabetes. To learn more, download the research brief.

This study makes it clear that initial predictions about your exchange populations might not always be accurate, making it even more important to leverage data in your planning. By analyzing your first-year exchange members’ cost, utilization, and demographics data, you’ll be able to answer these questions:

  • What are the profitability drivers of my ACA-compliant plans?
  • What disease management programs can we implement or expand to control cost and utilization while closing gaps in care and improving our members’ overall health?
  • What are the best outreach methods that my ACA membership will respond to based on socio-demographic characteristics?
  • Based on the characteristics of my current ACA membership, what populations should I be targeting to grow my membership?
  • How can I provide actionable analytics to incentivize and appropriately reimburse my provider community so that they better manage this new membership? 

Answering these questions is vital to the success of your plan, but gathering and analyzing exchange member data is task that requires advanced analytic skills and methodologies. Contact us to learn how you can get started. 

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

Beyond Claims & Assessments: Understanding Your Population Drives Results

By Tom Halvorson/Tuesday, May 19, 2015

Within healthcare analytics, we are constantly striving to drive action. We pore over data to make meaningful recommendations. Our business demands that we effect change in our health plans, our providers, and more often than not, our employees or members. Administrative claims can tell us a lot about an individual. A health risk assessment (HRA) can tell us even more.

But even with these rich data sources, we’re still missing the complete picture. What makes a person tick? What barriers prevent them from seeking preventive care?  Do they prefer to receive information via mail, the internet, or TV ads? What shops and restaurants do they frequent? 

Combining administrative claims with lifestyle segmentation and survey data can help bridge this gap and allow health care decision makers to make the kind of profound discoveries that lead to action. The right tool and analytic expertise are needed to merge these disparate data sets.  

Recently, a health plan client applied Market Expert® — a Truven Health tool that combines Nielsen PRIZM® lifestyle segmentation with our PULSE™ Healthcare Survey and the CDC Behavioral Risk Factor Surveillance System — to its existing members to understand what population segments were the most desirable from a business standpoint. The plan then used the tool to scan its service areas for more people in those segments. Beginning with a solid understanding of its ideal market demographics, this insurer was able to predict the healthcare needs of the unknown individuals and craft programs and perks to target and incent prospective members. The data provided clear insights into the most effective ways to communicate with this market. 

Another employer client wanted to increase HRA participation and act on the results. Using Market Expert, the organization started by parsing its population to understand what participation incentives would be the most appealing. Then it examined the most effective forms of communication for the population segments. This consumer-oriented strategy was successful, creating a substantial increase in HRA participation. The HRA led the employer to discover a previously unknown mental health issue in the population. This insight helped explain recent productivity declines, and the employer was able to design an effective intervention.  

Employers have also used data to increase their Flexible Savings Account (FSA) participation. In one case, the employer and its employees realized a decrease in payroll taxes when the organization effectively educated and encouraged members on the use and maintenance of the FSA. By segmenting their population into meaningful groups, the employer created four different targeted communication methods. Tools like Market Expert enabled this employer to marry demographic and lifestyle data to create target profiles for its employees and their families. Contact us to learn more.

Tom Halvorson
Director, Analytics & Consulting

EDGE Server Data Submissions: Do You Need Help?

By Bryan Briegel/Monday, May 18, 2015


Now that the April 30 CMS deadline for submitting EDGE server data – and even the May 15th grace period – has passed, it’s a great time to step back and evaluate how your organization did.

We think a few key questions to ask are:

 ·         How well did our approach to EDGE work?

 ·         Did we have clean data to optimize our risk adjustment efforts?

 ·         Were we able to respond to the constant change in CMS requirements in an effective manner?

 ·         What improvements do we need to make?

 The ACA has made an already complicated, competitive business even harder. And 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. Even large health plans with corporate supports in place were hard-pressed to meet the 2014 requirements.

If you think there’s need for improvement, now’s the time to consider a new plan of attack for your 2015 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

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, Director of Operations
Anita Nair-Hartman, Vice President, Payer Strategy and Business Operations

The Burden of Hepatitis C Infection

By Truven Staff/Thursday, May 14, 2015

Infection with hepatitis C virus (HCV) may lead to devastating health problems such as cirrhosis or cancer of the liver, which may develop decades after the initial infection. Although the incidence of HCV infection peaked in the late 1980s, roughly 3.2 million people in the United States today have a chronic infection. Given the long course of this disease, the medical consequences of HCV and related direct and indirect costs are continually rising. The estimated total nationwide cost associated with hospitalizations for HCV infection with advanced liver disease is $34.7 billion per year[1]. 

Clinical research demonstrates that the consequences of HCV can be mitigated with appropriate antiviral treatment. However, patient adherence is challenging due to lack of awareness and tolerability issues. We recently completed a study examining the medical costs and lost work productivity among patients diagnosed with and treated for HCV between 1997 and 2012. Our results show that patients with the shortest duration of treatment exhibited the highest post-treatment total and HCV-specific costs and lost productivity over time. Specifically, patients with the shortest duration of treatment had about 50% greater total health costs, double HCV-specific costs, and 20% greater short term disability days. The data further show that due to low cure rates, rates of re-treatment are high. 

These results provide an important baseline for understanding the significant unmet needs for HCV patients treated with the older interferon/ribavirin regimens and the opportunity for newer treatments to better facilitate appropriate adherence, improved patient health, quality of life, work productivity, and reduce the need for re-treatment.

 This study and white paper are available at http://truvenhealth.com/wp/inc-treatment-cost-impact-hepc 

This study was funded by Pharmaceutical Research and Manufacturers of America (PhRMA)


[1] Xu F, Tong X, Leidner AJ. Hospitalizations and costs associated with hepatitis C and advanced liver disease continue to increase. Health Aff (Millwood). 2014 Oct;33(10):1728-35.