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The Truven Health Blog


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


Health Plans: Choose Your Initial Validation Audit Vendor Wisely


By Anita Nair Hartman/Tuesday, March 21, 2017


For health plans, the time to select an initial validation audit (IVA) vendor is drawing near. Selecting a qualified vendor should be a thoughtful and informed process. If the audit shows a plan’s EDGE data are not valid and have risk score-impacting errors, the Centers for Medicare & Medicaid Services (CMS) may act to scale down the plan’s premium risk transfer payments, which may incur negative results for the plan’s financial performance. As a CMS-accepted IVA entity, we’ve been partnering with health plans to meet this requirement since the law was implemented.

CMS developed IVA requirements to help ensure that accurate and complete membership and risk adjustment information is submitted by health plans to the EDGE servers for eventual payment transfer calculations. According to the regulations, qualified commercial health plans must have an independent auditor with certified coders review medical records for 200 random members (or less if the Finite Population Analysis applies to the issuer) selected by CMS and must validate the enrollment and the diagnosis codes submitted. The deadline to select a vendor for this year is April 28, 2017.

 Medical records review is a critical part of the validation process, so health plans should consider experience and certification when selecting a vendor. Some other important qualities to look for in an IVA vendor are:

●      Deep knowledge of ACA regulations. A vendor should have a history of monitoring, evaluating, and influencing the changing ACA requirements.

●      Data, analytics, and auditing experience. A long history analyzing large claims databases and auditing healthcare claims, and prior experience with CMS-mandated reporting, are critical experiences.

●      Experience with EDGE servers. To efficiently audit EDGE data, the vendor needs experience with EDGE data format and content, and in processing large amounts of data.

●      Risk and reinsurance expertise. Look for an auditor with experience with risk models.

●      Flexible approach. This is not a completely straightforward process. Every health plan is different, and your vendor should be able to implement a solution to meet a health plan’s specific needs.

●      Certified coders. This one is straightforward. By law, the coders must be certified by the American Health Information Management Association (AHIMA) or the American Academy of Professional Coders (AAPC).

●      An IVA Approved by CMS. Plans must choose from a list of CMS-accepted entities.

Selecting an experienced and qualified partner to support the IVA will help give health plans peace of mind in managing the IVA requirements. 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, and IVA vendor, so you can get back to the business of offering quality health care. Contact us to learn more.

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


The Effects of Telecommuting Intensity on Employee Health

Chosen as AJHP Editor’s Pick for 2016


By Truven Staff/Friday, March 10, 2017

 

The number of employees who take advantage of telecommuting has increased substantially in recent years - especially with the improvements in technology and the increasing demand for more flexible work schedules. The Effects of Telecommuting Intensity on Employee Health, recently chosen as Editor’s Pick for 2016 by the American Journal of Health Promotion (AJHP), highlights how the employees at Prudential Financial, a company with a long history in promoting work flexibility are affected by telecommuting - specifically in relation to their overall health.

Over a two-year period, Prudential Financial, in partnership with Truven Health Analytics®, IBM Watson Health™ analyzed the amount of time employees spent telecommuting and what potential health risks arose because of it, including depression, stress, poor nutrition, physical inactivity, tobacco use, alcohol abuse, and obesity.

The research suggested that telecommuters had a lower risk of developing many medical ailments, including obesity, alcohol abuse, physical inactivity, and tobacco use. The study also found evidence that employees who engage in a small number of telecommuting hours were less likely to develop depression. While the study provided some evidence to suggest that flexibility with telecommuting has health benefits, maintaining some level of in-office work may help to strengthen spiritual and social health.

 Download the full study here.

 


Some of our highlights from HIMSS 2017


By Truven Staff/Monday, February 27, 2017

Last week, representatives from Truven Health Analytics, now part of the IBM Watson Health business, and more than 40,000 health IT professionals, clinicians and executives attended HIMSS 2017 in Orlando, FL to learn from health industry leaders, see the newest products and services and get an idea of what’s ahead in healthcare.

Here are some of our highlights from this year’s HIMSS conference:

  • Launch party for Portable Analytics and new cognitive offerings: Truven Health Analytics and IBM Watson Health celebrated the launch of several new offerings, including Portable Analytics. This is an enterprise analytics solution that enables health plans to embed robust analytic content from Truven Health into their own technology environments. A similar offering is available for providers.
  • Speaking session in IBM Presentation Theater: You’ve got the data, now get the answers: Truven Health and IBM experts Kevin Ruane and Rich Hennessy, respectively, showed a diverse audience of healthcare stakeholders how they can improve performance through data and insight with our portable analytics. Click here to schedule a demo and see for yourself.
  • Black Book award for population health solution: IBM Watson Health was recognized by Black Book™ for its best-in-industry population health solution. Click here to read an article about the Black Book™ best-of-breed study.

Contact us to learn more about our new solutions that were unveiled at HIMSS 2017.

 


The EDGE Server Data Submission Requirement Is Alive and Well. How Is Your Process?


By Truven Staff/Wednesday, February 1, 2017



Although the future is always uncertain, there are ongoing, complex reporting requirements we know health plans must meet in 2017. EDGE server data submissions are as challenging as ever, and health plans must submit complete 2016 benefit year data by May 1, 2017. 

Accurate and complete data submissions are a must to ensure that you present the actual risk of your member population and maximize your reinsurance and risk transfer payments. Was your EDGE server software stack upgraded to the new CMS requirements by January 31, 2017 – and are you feeling prepared? We think a few key questions to ask are:

  • How well is our approach to EDGE working?
  • Did we have clean data that optimized our risk adjustment efforts?
  • Were we able to respond effectively to the ongoing changes in CMS requirements? Most recently, how has our CMS-required EDGE server re-imaging and software stack upgrade gone?
  • What improvements do we need to make to maximize our return on our EDGE efforts?

The difficulties in accurately capturing and presenting your members’ risk and effectively processing EDGE data become abundantly clear when health plans receive their annual risk adjustment transfer payment reports from CMS each summer, and many are unhappy. The fact is that many health plans, busy serving their members by supporting quality care at a reasonable cost, simply don’t have the requisite resources or experience in place to complete the arduous tasks needed to comply with EDGE server data submissions. EDGE server requirements are challenging—and continue to evolve.

If you think there’s opportunity for improvement, now’s the time to consider a new direction for your 2017 benefit year submissions. Should you do it on your own? Stick with a vendor you’re not thrilled with? 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 optimization services
  • Data management setup and continuous data management services
  • Analytic reporting
  • A support staff to keep up with HHS changes and respond to EDGE server updates
  • Peace of mind and the ability to focus internal resources on 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



Evidence That Telecommuting May Improve Employee Health


By Rachel Mosher Henke/Friday, December 16, 2016

 More people than ever work from home one or more days a week. The practice of telecommuting has taken the business world by storm.  Improvements in technology, the demand for more flexible work schedules and cost reduction strategies have contributed to this trend which has seen a dramatic increase over the last several years. Even people who live close to their place of work may take advantage of working remotely to eliminate commute time and provide flexibility to take care of midday appointments or family needs.  

Most of the attention on telecommuting has focused on how it impacts work productivity and opportunities for promotion.  But an important factor has been largely overlooked and absent from consideration – employee health.  Employers and employees can both benefit from learning how telecommuting affects health. 

Prudential Financial, a company with a long history in promoting work flexibility, in partnership with Truven Health endeavored to fill this gap and understand what affects telecommuting has on their overall employee health.  The research study looked at amount of time telecommuting and potential health risks including depression, stress, poor nutrition, physical inactivity, tobacco use, alcohol abuse, and obesity.

Studying a time period of two years, our research suggests that telecommuters had lower risk for obesity, alcohol abuse, physical inactivity, and tobacco use.  We found evidence that employees who engage in a small amount of telecommuting hours are likely to benefit positively from the activity including reducing their risk for depression.

The connection we found between telecommuting and lower health risks further strengthens the business case for support of flexibility and the connection between work-life and health.  However, it is important to note that while our study provides some evidence to suggest that flexibility has health benefits, maintaining some level of in-office work may help to strengthen spiritual and social health. In the case of 100% remote workers, managers may want to ensure extra effort is made to stay connected to those workers and create inclusive opportunities with the rest of the team.

The study timeframe was only two years, so more research is needed to understand the longer term impact of working from home on health. The results from our study of the Prudential program are specific to their employee programs.  And though not generalizable employers and health plans may be curious to see whether these health benefits translate to health care savings for their organizations. 

Truven Health Analytics is encouraged and eager to help organizations examine the relationship between telecommuting intensity and health outcomes. 

You can read more about our findings by downloading the full research brief, The Effects of Telecommuting Intensity on Employee Health.

Rachel Henke
Senior Director Behavioral Health and Quality Research

 


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