The Truven Health Blog

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


The Newly Insured Don’t Turn into Primary Care Physician (PCP) Loyalists Overnight

By Truven Staff
Linda MacCracken imageWhen looking at the impact of the newly insured, the Philadelphia market’s experience of an 8% rise in emergency department (ED) use is notable. Moving from uninsured to insured status may happen in a day, but new health service use habits take time. The impact of the newly insured – via Medicaid expansion or private exchanges – is still unfolding.

Truven Health forecasts on the impact of the newly insured mirror the statistics noted in the Philadelphia Inquirer article, “With Health Law, ERs Still Packed.” In fact, young adults and children are more likely to use an ED when they have insurance versus when they had less insurance. Surprisingly or not, children, Millennials and young Gen Xers are not primary care physician (PCP) loyalists.

Join our webinar “What to Expect from the Newly Insured” to get highlights on what to expect, tips on how to prepare, and how to realize higher profits and deeper customer engagement.

Linda MacCracken
Vice President, Advisory Services

Planning Strategies to Bridge Fee-For-Service and Value-Based Care

By Truven Staff
Linda MacCracken imageIn today’s market, providers planning for service reconfiguration are focusing on several areas: physician networks, outpatient networks, payer risk initiatives, acute care provider partnerships, and pre-/post-acute care provider partnerships. Driven by healthcare reform, the provider delivery system is rapidly consolidating and contracting in new ways. With the new risk and value-based reimbursement incentives, hospitals and health systems have to develop comprehensive care networks that will provide the right care, at the right price, in the right setting.

So how do providers begin to bridge fee-for-service and value-based care? With strategic planning. In fact, strategic planning has never been so important. Being willing to make new connections and take risks will be hallmarks of a successful planner.

Using the same approach to strategic planning and involving the same planning stakeholders won’t work under healthcare reform. Planning processes need to be more flexible, frequent, and adaptive to ensure that hospital leaders have a strategy for acquiring and delivering care through partnerships.

How can hospital planners get started?
  1. Engage a larger group of internal stakeholders in the strategic planning process, such as physician leadership; fiscally aligned physicians via the physician-hospital organization (PHO) or employed group practices; and senior clinical and operational leaders.
  2. Prepare capacity for the arrival of the newly insured.
  3. Coordinate the outpatient network with the strategic business plans.
  4. Leverage performance best practices.
  5. Establish provider partnerships with pre- and post-care delivery providers.
  6. Assess payer risk initiatives by episode-driven care.
Complete a short form to download the full issue brief.

Linda MacCracken
Vice President, Advisory Services

Three Reasons Why It’s a Good Thing Hospitals Are Engaging in Health Insurance Exchange Plan Enrollment

By Truven Staff
Mike Taylor imageAn article last week in the Washington Post (“Hospitals Emerging as Powerful Healthcare Sales Force,” by Jay Hancock, Sept. 13, 2013) explored a growing trend in the world of healthcare reform — the role of hospitals in recruiting newly eligible consumers for insurance coverage.

As the new health insurance exchanges, or marketplaces, open for business next month, research from Truven Health about the Accountable Care Act shows that an additional 21 million people will be eligible for coverage in 2014.

For hospitals, that number represents potential revenue from a fresh, newly covered market — new revenue from patients who did not seek out medical care in the past because of financial barriers, and from uninsured people who sought out care but couldn’t pay their medical bills.

Obviously, then, it’s a smart move for hospitals to help those new consumers enroll in coverage. But there are other reasons why this trend is positive: 

  1. Hospitals and health plans need each other to impact higher-quality care. In the past, hospitals and health plans worked for opposite incentives. Hospitals were rewarded for higher numbers of services performed. Health plans wanted to keep the number of services rendered low. Now as a result of reform that rewards quality, not quantity of care, the two entities are coming together — particularly when partnering in risk contracts — to figure out how to measure, manage, and deliver higher-quality outcomes. The trend is indicative of the transformation going on in healthcare as we move from a fee-for-service to a value-based purchasing model. 
  2. Hospitals must do whatever it takes to protect their market share. It makes good business sense for hospitals to protect their existing market share in a complex environment where things are changing rapidly. Closely partnering with insurance plans and helping patients find the best plan for them are two avenues to prevent erosion and boost patient loyalty and engagement. 
  3. Patients will ultimately benefit. A lack of transparency has been a problem — with different contracts for different plans driving care costs. But with stronger affiliations between hospitals and health plans, transparency should increase, with consumers gaining a better understanding of price points.
Another important benefit for consumers is that once a hospital helps a person get enrolled in a plan, he/she can take advantage of preventive care. That should mean less ER visits — and better chronic condition management.

In addition, hospital-health plan alignment paves the way toward better population health data and analytics  — which the hospital can act on to improve overall community health.

Finally, the fact that hospitals are actively recruiting for exchange plans is directly tied to healthcare’s overall bottom line. The more people who are insured, the fewer write-offs are needed. That should trickle down to better pricing for consumers. But for that to happen, the new exchanges need to sign up enough of the newly eligible — many of who are young, healthy people who don’t see a need to enroll. The more recruiting help exchanges get from all sides, the better for all consumers.

Note: For more information on the population that is newly eligible for coverage through health insurance exchanges, view our infographic, “Unmasking the Uninsured Population in Your State.”

Michael L. Taylor, MD FACP
Chief Medical Officer

Rate Setting by Insurance and Exchanges

By Truven Staff
Anita Nair-Hartman imageAs the October 2013 open enrollment date for insurance marketplaces approaches, more information is emerging on how states are managing the premium rates set by health insurers. Maryland is an example. As a recent Washington Post article noted, this state is working diligently to ensure affordability for consumers in its market.

Questions remain: How easily does the open enrollment work for consumers? And are states or the federal government able to support consumers as they navigate the healthcare maze and try to understand their out-of-pocket costs and assess the best plans for their situation? Consumer understanding of plan design options and their associated costs, as well as their subsidies, will be the ultimate test of the work states and federal government did to keep rates low. We’ll know in October whether consumers were adequately supported

Anita Nair-Hartman
Vice President Market Planning and Strategy

Health Plan Support of the Newly Insured

By Truven Staff
Anita Nair-Hartman imageA recent Kaiser Health article discusses the premiums consumers will face in the new public exchanges. There has been much market focus and press on the rates that consumers will be charged and the potential impact to enrollment. Although this is an important topic, equal attention should be focused how we will manage these newly-insured consumers. From research that Truven Health completed earlier this year titled, Coverage Expansion Under the ACA: Challenges for Government, Health Plans, and Providers, we know that there is limited information in the market on this subset of consumers.

Our research indicates that these newly insured will be less healthy, currently use services at a lower rate, and have gone long periods without coverage due to insurance cost. All of this research suggests that the newly insured will most likely have service needs that they have deferred and will present challenges for the health plans who cover them. It will be critical that health plans support these new consumers with tools and services to help them understand and navigate their new health care coverage. As we have noted in the past, consumers who have more information are able to make wiser decisions about their healthcare choices. And this leads to improved quality, lower costs, and higher satisfaction with their health plan and exchange.

Anita Nair-Hartman
Vice President, Market Planning and Strategy