Media Room

For Immediate Release

Truven Health Analytics Launches Cost-Sharing Reduction Analysis and Reconciliation Solution for Health Insurance Exchanges

Ann Arbor, MI, Jun. 09, 2014 — Truven Health AnalyticsTM , a leading provider of healthcare analytics and data solutions and services, today announced the launch of a new cost-sharing reduction analysis and reconciliation solution designed to reduce the administrative burden on qualified health plans. Developed as part of Truven Health’s suite of Affordable Care Act (ACA) Exchange Solutions, the new analytic offering helps health plans accurately forecast their cost-sharing obligations for enrollees who are eligible for income-based out-of-pocket cost reductions.

“Our quick-to-market solution addresses new regulatory requirements and offers early insights for health plans to effectively manage this potential liability, ” said Mike Boswood, president and CEO of Truven Health Analytics.

Under the ACA, lower-income individuals who purchase health insurance through an exchange are entitled to participate in cost-sharing reduction programs, which limit out-of-pocket spending for items such as office visits and prescription drug co-pays. Qualified health plans receive payment from the Centers for Medicare and Medicaid Services (CMS) in advance of service, based on estimates of their total cost-sharing exposure over the course of a year. At the end of each year, these payments must be reconciled with CMS, either via a “simplified” methodology based on actuarial estimates or via standard, audited reporting.

“With approximately 80 percent of individuals enrolled in silver-level plans currently eligible for costsharing assistance, budget forecasting and reconciliation processes present significant new challenges for health plans, ” said Barb Graovac, Senior Vice President at Truven Health Analytics. “Our cost-sharing reduction services make it possible for health plans to quickly gauge their exposure and immediately make any necessary adjustments to ensure that they are aligned with program requirements.”

The Truven Health cost-sharing reduction analysis and reconciliation solution was developed to help health plans accurately forecast cost-sharing exposures, validate payments to eligible members, and reconcile year-end results. Truven Health is also working with Wakely Consulting Group, the leading actuarial services consulting firm servicing the healthcare industry, to provide actuarial certification for health plans requiring that service.

According to a Truven Health Analytics survey of ACA Silver plan health insurance providers, 55 percent of respondents said they plan to conduct a simplified cost-savings reduction reconciliation this year, while 45 percent said they would use the standard method. By implementing Truven Health’s costsharing reduction services, health plans are able to easily execute both approaches with the utmost accuracy.

For more information on the Truven Health suite of ACA Exchange Solutions, please click here: http://truvenhealth.com/your-healthcare-focus/health-insurance-exchange

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