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For Immediate Release

Truven Health Analytics Finds One State’s Health Insurance Exchange Attracted Older, Sicker Patients

Ann Arbor, MI, May 18, 2015 — Individuals enrolled in a state health insurance exchange are older and require more care than their off-exchange counterparts, according to an in-depth analysis of one state’s insurance claims data conducted by Truven Health Analytics™.

Truven Health Analytics partnered with a large health plan to investigate demographics, risk, financial factors, and utilization patterns in the exchange population of its state. The study found that – despite pre-ACA predictions that exchanges would attract younger patients – the average enrollee age for the exchange population was 46 years, compared to 44 years for those off the exchange. Additionally, the exchange enrollees required significantly more admissions and emergency care than non-exchange patients.

Report findings include:

Exchange Attracted Older Patients: Pre-exchange enrollment forecasts suggested that exchanges would attract younger people, thereby offsetting the higher utilization and costs incurred by the older populations. However, Truven Health found the opposite to be true in the exchange population analyzed in this study. The average enrollee age was 46 for the exchange population and 44 for those off the exchanges. Only one plan – the catastrophic level – had an average age under 44 (31 years).

More Admissions, ED Visits: Enrollees on this state’s exchange had 39 percent more admissions and 64 percent more emergency department (ED) visits per 1, 000 enrollees than non-exchange patients. Additionally, the study found that medical and prescription drug utilization increased as the plan design level increased.

Higher Rate of Chronic Conditions: Exchange patients were also more susceptible to costly chronic conditions, specifically heart failure and diabetes. The analysis found 44 percent more instances of congestive heart failure and 39 percent more diabetes cases in exchange patients. Additionally, exchange patients experienced more seizure disorders and convulsions (26 percent), asthma (21 percent) and major depressive disorder (8 percent) versus non-exchange counterparts.

Silver Plans Dominate Exchanges: Silver plans (including both standard silver and cost-sharing reduction plans) are the preferred plan of choice for exchange enrollees, with an 82 percent market share. Bronze enrollees accounted for just 6 percent, while platinum had 4 percent of the market.

“Now, more than ever, health plan leaders need to understand details about their unique populations to create appropriate product strategies and plan designs for the future, ” said Barbara Graovac, senior vice president at Truven Health Analytics. “With this snapshot of one state’s exchange population, it becomes clear how profound the differences between an exchange and off-exchange health plan population can be, and, how different reality is from initial predictions.”

Truven Health Analytics was able to conduct this analysis through a partnership with a large health plan operating a state health insurance exchange. By digging into the detailed health claims data for this plan’s members and applying its proven healthcare cost and utilization analytics, Truven Health was able to draw some early conclusions about their overall health and cost profile.

For this analysis, Truven Health researchers used most recent data available — the health plan’s claims as of September 2014 — to compare ACA enrollees on the exchange with those off the exchange. To be part of the analysis, members had to be continuously enrolled for at least five months and be at least 21 years old.

Download the full report here.

About Truven Health Analytics, part of the IBM Watson Health Business

Truven Health Analytics®, part of the IBM Watson Health™ business, provides market-leading performance improvement solutions built on data integrity, advanced analytics and domain expertise. For more than 40 years, our insights and solutions have been providing hospitals and clinicians, employers and health plans, state and federal government agencies, life sciences companies and policymakers, the facts they need to make confident decisions that directly affect the health and well-being of people and organizations in the US and around the world. The company was acquired by IBM in 2016 to help form a new business, Watson Health. Watson Health aspires to improve lives and give hope by delivering innovation to address the world’s most pressing health challenges through data and cognitive insights.

Truven Health Analytics owns some of the most trusted brands in healthcare, such as MarketScan®, 100 Top Hospitals®, Advantage Suite®, Micromedex®, Simpler® and ActionOI®. Truven Health has its principal offices in Ann Arbor, MI, Chicago, IL, and Denver, CO.


Brian Erni
For Truven Health Analytics
J. Roderick, Inc. Public Relations