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The Truven Health Blog


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


Helping People Make Better Healthcare Decisions with Advanced Analytics


By Mike Boswood/Wednesday, June 3, 2015

(Previously posted on IBM’s asmarterplanet.com) 

Sparked by a need to reduce costs and fueled by the Affordable Care Act, the healthcare industry is moving to a retail-based, consumer-oriented model. 

As a result, individuals are taking on greater responsibility for their care – including choosing which treatment option is best for them, which provider they’d like to use, and how they want to spend their healthcare dollars. This is a challenge for many people who don’t have the information they need to make smart, well-informed healthcare decisions. 

It’s also a struggle for health plans. Meeting consumer demands for tools to support decision making is just part of their challenge. In addition, health insurers are undergoing rapid internal change as they shift to an individual business model in response to health insurance exchanges and Medicaid expansion. 

In order to effectively manage the care of a growing population, including the newly insured, health insurers need tools that can provide granular detail on individual healthcare experiences, identify patterns of behavior, and quickly spot outliers for intervention. 

Advanced analytics can help. But only if the analytics are combined with “good” data and a deep understanding of the healthcare landscape.

By integrating proven analytic methods and industry expertise from Truven Health with IBM’s Enterprise Health Analytics platform, we can help health insurers leverage technology and analytics in new ways to improve the quality and value of care. With this combined solution, health insurers and their associated health systems can bring together structured and unstructured data sources from payers, providers, and consumers to identify gaps in care, handle financial reporting and manage cost requirements. They can also use the insights gleaned to assess program and provider performance, ensure payment integrity, and monitor compliance and prevalence over time. 

For example, health insurers will be able to identify patterns of disease management for enrollees with chronic conditions like diabetes, segment those by region, provider, and cost, and then measure any changes over time or even chart changes in the impact of different preventive measures on the conditions. All of these inputs can be used to evaluate quality of care and – ultimately – to drive value-based reimbursement models that will reward providers that deliver the best care at the best price. 

In addition, IBM’s Consumer Price Transparency solution, which streamlines the process of shopping for a procedure or facility, will now incorporate healthcare pricing estimates from Truven Health. The retail shopping solution will leverage IBM’s robust commerce platform and Truven’s proven methodologies to calculate real-time, personalized, out-of-pocket costs for a wide variety of medical procedures and treatments, making the promise of data analytics a reality for everyday consumers who can now comparison-shop for the best quality care based on targeted, empirical evidence, not a gut decision. 

We are entering into an era where data and technology are aligning to make amazing things happen. Properly used, the most promising analytics will help health insurers respond to today’s rapidly changing healthcare environment and empower people to become educated consumers of healthcare.

Mike Boswood 
President and CEO


 


Dear Employer, Offering Health Plan Choice Alone Is Not Enough


By Chet Winnicki/Thursday, April 2, 2015

Chet Winnicki photoA recent Employee Benefit News article, Many Employees Need Help Picking the Best Health Plan, put some clarity around what we’ve long suspected by sharing details of an Employee Benefit Research Institute study. The study found that nearly half of polled employees consider choice of health plan extremely important, and 36% rate it as very important.

We know plan choice is good. But it’s not enough: the same study found that one-fifth of employees are not confident they can make the best plan choice. Health plan choice during open enrollment can and should be a great experience for employers and employees. As an employer, you’re enabling your employees to enroll in the “right” plans for their healthcare needs, and that’s a real opportunity for both of you to save money: When fewer of your employees over-insure themselves, your healthcare contributions will be reduced as well.

Unfortunately, it’s not that simple.  Despite the time and effort you put into providing plan choices, if you’re offering them without a decision support tool, you’re only creating an opportunity for change. Health plan choice can only reach its full potential when employees pick the best plan for their needs. But according to Aflac’s 2014 Open Enrollment Survey, 90% of American workers choose the same benefits year after year, and 64% say they rarely or never understand the changes in their benefit coverage.

So what’s so hard about forecasting healthcare needs and selecting the best plan? Actually, it’s pretty complicated. Before making an informed decision, employees must consider how much they spent on healthcare in the past, the health status of their family members and costs of any expected treatments or surgeries, and whether they’ll be adding or subtracting any dependents. Their next important step would be to apply their cost forecast against each of the plan options, which includes answering these questions:

  • What will your paycheck premiums total for the year?
  • How much will you pay out-of-pocket before your deductible? How about after your deductible and up to your out-of-pocket maximum?
  • In case you underestimated your healthcare needs, what’s your out-of-pocket maximum?

And we’re not done. High deductible health plans (HDHPs) and the spending accounts (e.g., HSAs, FSAs) that often accompany them add yet another layer of complexity. How will your employees know how much to contribute?

 

With all they need to know, can we really expect the average consumer to choose the right plan without help and guidance? The answer is absolutely not. Without guidance, your employees are likely to feel confused and frustrated, and believe that you’re passing more healthcare expenses on to them. Employee discontent with the health benefits and open enrollment can lead to job dissatisfaction and lower morale. And open enrollment confusion can burden your human resources staff. In a 2014 survey of human resources executives, nearly half (47%) said that educating employees about health benefits is the most difficult aspect of open enrollment.*

The good news is there are consumer web tools that do this heavy lifting, helping employees forecast their healthcare spending by providing a personalized experience and then recommending the best plan to meet their needs. 

The best of these decision support tools combine an employee’s own historical claims data with a robust, time-tested health care claims database to estimate the cost of conditions or future treatments that are geographically relevant to the employee.  

Plan choice is a great thing, but choice without decision support is a missed opportunity and may actually create employee dissatisfaction. This fall, make the most of the choices you offer your employees by pairing open enrollment with a great enrollment tool.

Chet Winnicki
Senior Director, Product Management

*Keas 2014 HR Executive Survey – Full Report.


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