Pay or Play Health Plan image

Pay or Play

To Pay or To Play?
That is the Question.

Your employer clients will need to act quickly to refine their strategy for “Pay or Play” and position themselves to make timely and effective decisions for 2014 and beyond.

According to our latest research, federal insurance exchanges may be twice as expensive for employers as group health plans.

To help you measure the impact of the Patient Protection and Affordable Care Act (PPACA) on your clients and their employee population, Truven Health Analytics developed a data-driven Pay or Play model founded on healthcare claims datasets covering 39 million lives for more than 300 companies contracting with all major carriers, third-party administrators, and pharmacy benefits managers.

The custom-built model has been adapted to scale down to your clients’ individual situation and can help them project the effect of the new regulations will have on their benefits costs through 2020 and quantify the impact of compliance with legislative mandates (“Play”) versus paying the penalty for noncompliance (“Pay”). The model considers:

  • The direct benefit and tax cost of eliminating group health benefits
  • The impact of the Cadillac Tax in 2018
  • The compensatory cost for employees if employers eliminate group health benefits, requiring employees to purchase healthcare through an insurance exchange

Our process includes a kick-off meeting to understand the organization's goals for compliance. We present model results and ensure your client has a comprehensive understanding of their options under Pay or Play. Depending on their needs, we can develop additional modeling scenarios and help guide the organization in understanding practical approaches to complying with the regulation.

In addition to the PPACA, there are several other trends already well underway in the movement to create a more enduring American healthcare system. Our recent white paper, Beyond the Patient Protection and Affordable Care Act: Enduring Trends in Healthcare, identifies five themes that will impact you and your clients’ ability to further navigate the turbulent healthcare environment.