The Truven Health Blog

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

What Data Is Needed to Run an At-Risk Organization?

By Larry Yuhasz/Thursday, December 19, 2013
Larry Yuhasz imageThe recent article, “Seven Changes the Affordable Care Act will Likely Encourage in the Medical System,” discusses several new approaches to healthcare that rely on effective management of new data sources and data streams. The ripple effects of the Affordable Care Act will take on many dimensions, ranging from the operational work flow of a health network, to the revenue cycle of those entities going at risk, to the relationship between patients and providers, to the way providers prioritize and spend their time with patients. Given this level of dramatic change, Truven Health Analytics is developing development partnerships with select customers to focus on the required flow of information that will be needed to run at at-risk organization, and the types of analytics and decision support various roles throughout a health network will need to have.

At the center of these activities is the fundamental requirement to establish a single patient record that accumulates knowledge of the patient through each and every encounter. Furthermore, the data collected needs to be organized and acted upon given specific temporal requirements. There is data used for an initial encounter, data for diagnosing, data for monitoring treatment effectiveness, and data for determining overall quality and effectiveness over time. Each requirement has specific conditions, and potentially, limitations, based upon how robust the single patient record is or is not. For example, encounters with new patients where no background information exists will be treated differently than encounters where there is a rich patient history of information. Likewise, encounters with healthy patients may provide the opportunity to collect new data insights into behavioral measures that can be used to keep them healthy, whereas patients with chronic conditions will likely require insights collected related to improving compliance to care guidelines.

In many respects, we may see a future where each encounter has both a patient care and an information care component with it. In fact, patient care and the required work flow is intimately connected to the information gleaned from diagnosis and the eligibility and payment and risk requirements the encounter triggers.

Larry Yuhasz
Director for Strategy and Business Development

Proactive Outreach Can Increase the Success of Price Transparency Solutions

By Matthew Collins/Wednesday, December 18, 2013
Matt Collins imageLast month, Suzanne Delbanco of Health Affairs wrote an excellent blog post pertaining to price transparency solution entitled: “Price Transparency Tools: The Good News, the Challenges, and the Way Forward.” This article does a great job of articulating how far price transparency solutions have come over the years, and more importantly discusses what still needs to be done to ensure that users are adequately engaged to ensure that people a) want to utilize the solution; and b) want to keep coming back. Indeed one of the biggest challenges with offering a price transparency solution is to ensure that people are aware of and want to visit the solution. To paraphrase Ms. Delbanco, just because you build it, doesn’t mean they will come. Having single digit usage rates is not what an employer or health plan offering a price transparency solution is hoping for.
So, this begs the question, how can these solutions entice consumers to want to visit them initially, and become repeat visitors? Plan design plays an integral role in driving solution usage. A consumer with a very rich plan will have very little need to spend the time doing research to find a lower-cost doctor. Consumer-driven health plans give consumers “skin in the game.” For consumers in these plans, a price transparency solution essentially becomes a requirement. When every dollar (prior to meeting a deductible) comes out of the consumer’s pocket, finding a cost-effective doctor almost becomes a necessity.

As Ms. Delbanco points out, once these consumers hit their deductibles, they will be less apt to make return visits. I would argue that having health education content and valuable provider-specific quality metrics within the solution will assist in enticing these consumers to return to the site even after meeting their deductibles. The thought here is that consumers will initially be pulled to the site in search of provider-specific cost information, but then realize the benefits of being able to research the procedures via helpful health education information, and research physicians via robust provider-specific quality information.

At Truven Health Analytics, we are utilizing health messaging to further increase engagement with our price transparency solution. We are able to send proactive monthly messages to a population about gaps in care, preventive screenings, and cost savings and drive them to the transparency solution website. We mine claims data on a monthly basis and look for opportunities to message to a population related to their heath and financial well being. These messages are then sent out via email, SMS text, or the postal service. In the case of the email and SMS messages, users receive a message that states that the user has an important health message waiting in their own personal secure mailbox. This secure mailbox can share the same website as the price transparency solution and the messages themselves can contain messages directing the user to learn more about the costs of the procedure or condition. As a result of marrying an outreach solution with a price transparency solution, we are seeing some very encouraging results in terms of usage, as well as repeat users.

Matt Collins
Director, Product Management

Emergency Departments are in the Center of the Healthcare Reform Storm

By Linda MacCracken/Tuesday, December 17, 2013
Linda MacCrackenThe recent New York Times article, As Hospital Costs Soar a Single Stitch Tops $500, discusses the cost of an Emergency Department (ED) visit. EDs are under intense scrutiny by all parties – payers, employers, providers, and the government – about cost, quality and patient-engaged care. In fact, nationally, 62% of ED visits are urgent care (not emergent), making them more of a “department of available medicine” than necessary. This varies across the country,  where some markets show ED usage at 42% urgent visit share, while others tower north of 90%. Avoidable visits or overuse are typical of both Medicaid/self pay and commercially insured individuals. A national savings of $4.4 billion is possible if 20% of ED visits are redirected to an alternative or lower-cost care site.

Reform-based Medicaid expansion implies more demand for EDs, and requires adequate actual or virtual capacity. The opportunity is to provide alternative care settings. Some providers have had success in offering preventive screening physicals, care at urgent care centers (that accept insurance) and direct one-one patient engagement. One health system was able to reduce ED business by $1.5 million in Medicaid/self pay by reaching out to “frequent fliers” (5 or more ED visits per year) and educate them that the ‘next time,’ they can get the same or more appropriate care at a community health clinic. Providing the right capacity for the right care type in the right service setting goes a long way to protect the ED for the truly medically needy.

Commercially insured patients can also over-use the ED. 29% of employer-paid commercially insured patients, presenting with both an unavoidable and emergent condition, belong in the ED. 42% could have been cared for in a primary care setting. The net savings for redirecting commercially insured visits to a physician office setting is $1171 per visit. This invites a structure for an urgent care service line in physician offices.

The New York Times article states that compared to alternative outpatient care, the price of an ED visit is high, especially from the view of the cost-accountable consumer. However, EDs provide crucial health services, and there is a price for those life saving resources. What types of care belong in the ED is another matter that underscores its role at the eye of the storm of shifting outpatient care. All stakeholders – payers, employers, consumers, the government, and providers – are participating in the shift.

For more details, please download one of these publications.
Delivering Profitable Growth Through Market Intelligence, Dunn, MacCracken, 2012
Avoidable Emergency Department Usage, HealthLeaders Media Fact File, October 2013

Linda MacCracken
VP, Advisory Services

Using Big Data in the Best Interest of the Patient

By Kathleen Foley/Wednesday, December 11, 2013
Kathleen Foley imageThe recent USA Today article, ‘Analysis of huge data sets will reshape health care’ highlighted many of the ways in which ‘big data’ are being used to improve healthcare in the United States. The linkage of data across hospitals, insurance claims, electronic medical record systems, and genomics databases are helping to identify more efficient treatments and high-cost patients, and determine best practices for treating patients with particular conditions.

Despite these benefits and many others, the creation of ‘big data’ assets is fraught with difficulties that may be limiting the true potential of existing data. In addition to privacy concerns and constraints which limit what types of data can be linked and by whom, there are issues around ownership and access to big data. Who should pay for the creation of these large data assets, and once created, who should have access? The answers are not straightforward and require the development of trust and a shared vision across many stakeholders.

Truven Health is actively involved in the development of data infrastructures to both create big data and facilitate analyses while guiding appropriate interpretation. One of the first areas of focus is the creation of cancer data assets. To facilitate research that will truly answer important questions for patients, providers, and payers, we are exploring all avenues for linking various data from claims data to EMRs to cancer registries. Only by combining data sources can we finally begin to address questions that will get the right treatment to the right patient at the right time. It isn’t just about generating big data, it’s also about knowing how to use it to generate knowledge that is a game changer.

Kathleen Foley
Senior Director, Strategic Consulting (Life Sciences)

Employers Can Learn a Valuable Lesson From Exchanges

By Matthew Collins/Monday, December 9, 2013
Matt Collins imageThe opening of the health insurance exchanges this fall has certainly put a spotlight on a few of the things that can go awry during insurance enrollment. But there are some important lessons that can be learned from it – lessons that can help employers as they begin to plan for next year’s open enrollment.

For instance, the exchanges attempted to guide consumers through the process by presenting premiums and designs of all the available plans, so quick cost comparisons could be made. That’s a good start for helping consumers choose the right plan, and a best practice already in place for most employers.

But it didn’t go far enough.

To be successful, the process is missing a key element: A truly personalized experience that would help a user get a handle on his or her specific situation – especially varying annual out-of-pocket costs, in addition to the plan premiums.

Employers have the capacity to help employees better understand those costs by providing actual claims data history during the decision-making process. That data history can paint an accurate picture of past out-of-pocket expenses. In addition, employers can ask a few questions about planned procedures and other anticipated costs for the coming year, and incorporate that information into the decision process.

Without this level of tailored, data-driven experience, your employees may simply choose a plan with the smallest premium, which doesn’t always pan out as the best option given other circumstances. Providing this type of detailed data can also help employees plan better pre-tax healthcare savings account contributions, too, and minimize surprises.

Of course, doing everything you can to help employees select their best-fit plan has benefits for your organization, as well. Employers using Truven Health Analytics personalized enrollment tools have seen results like a 60 percent decline in the number of over-insured employees and a 20 percent increase in consumer-driven health plan enrollment.

For more ideas on how to make next year’s open enrollment successful for both your employees and organization – despite growing complexities and costs – check out our complimentary insights brief, Six Best Practices for Open Enrollment.

Matt Collins
Director, Product Management