The Truven Health Blog

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

 

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

By Truven Staff



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



EDGE Server Data Submissions: Do You Need Help?

By Truven Staff



Now that health plans have a couple of years of EDGE server data submissions under their belts, 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?
  • Were we able to respond to the changes in CMS requirements in a timely and effective manner?
  • What operational improvements do we need to make?

  • 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 missteps in meeting them have led to disappointing results, including leaving reinsurance dollars and understated risk scores on the table . Even large health plans with corporate supports in place have been challenged to meet the requirements.

If you think there’s a potential for improvement, now is the time to consider a new plan for your EDGE server submissions. Should you continue to go it alone or stick with your current TPA? Before you decide, consider all the things that a proper EDGE server process should entail.

Your solution should give you:

  • On-time, accurate submissions
  • Dynamic data management services, with constant updating to meet CMS changes
  • At a minimum, quarterly analytic reporting
  • Support staff to keep current with CMS changes and respond to their EDGE server inquiries and mandated server updates
  • 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, Healthcare Reform Solutions Specialist 
Anita Nair-Hartman, Senior Vice President, Payer Strategy and Business Operations



Understanding Your Exchange Population: Answering the Questions

By Truven Staff


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


Understanding Your Exchange Population: Answering the Questions

By Truven Staff


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


EDGE Server Data Submissions: Do You Need Help?

By Truven Staff


 

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




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