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May 2017 Commercial Bundles

With premiums on the rise and commercial payers interested in increasing the value return on their healthcare investment, more payers are considering value-based care arrangements. While CMS has led the charge to use bundled payments for joint replacements through the Bundled Payments for Care Improvement (BPCI) and Comprehensive Care for Joint Replacement (CJR) program, there is increasing interest in these arrangements from the payer market. As payers and providers begin to anticipate and plan for the change, it’s important to study bundled payments from a variety of angles looking at cost variations by region, market, provider type, and payers.

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April 2017 Hospital Performance

Winners of the Truven Health Analytics™ 100 Top Hospitals® designation demonstrate how effective leaders manage change and achieve excellence in a dynamic environment. Using the measures presented in our National Balanced Scorecard, this year’s 100 Top Hospitals® study revealed significant differences between award winners and their nonwinning peers. The nation’s top-performing hospitals had lower inpatient mortality, considering patient severity; had fewer patient complications; followed accepted care protocols for stroke care and blood clot prevention; had lower 30-day mortality and 30-day readmission rates; sent patients home sooner; provided more timely emergency care; kept expenses lower, both in-hospital and through the aftercare process; and scored 10 points higher on patient ratings of their overall hospital experience.

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March 2017 Mental Health and Substance Abuse Treatment Trends

Behavioral health and substance abuse treatment costs are rising, along with demand for these services, driven in part by the opioid abuse epidemic. The Substance Abuse and Mental Health Services Administration projects that by 2020, mental health and substance abuse (MHSA) treatment spending will total $280.5 billion, a 63% increase from 2009.* Increasing utilization of substance abuse services reveals an opportunity to expand treatment and prevention programs in-house or through partnerships. In addition, hospitals and health systems can respond to these rising costs and greater need by ensuring opioid prescribing patterns meet current guidelines and by instituting care management assistance when pain medications are necessary.

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January/February 2017 30-Day Readmission Rates Cardiac Hospital Performance

The Truven Health Analytics™ study of 30-day readmission rates uses Medicare Hospital Compare data to analyze differences in readmission rates among hospitals across the nation. Aggressive efforts are being made by the Centers for Medicare & Medicaid Services, private health plans, and providers to reduce unplanned hospital readmissions. This study examines 30-day hospital readmission rates from 2011 to 2015. Rates of 30-day unplanned readmissions have improved consistently during the five-year period.

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December 2016 Cardiac Hospital Performance

Cardiovascular care affects hundreds of thousands of patients annually and adds billions of dollars to overall U.S. healthcare costs. The Truven Health 50 Top Cardiovascular Hospitals study uses a national scorecard of metrics to identify the nation’s highest-performing cardiovascular services lines. If all cardiovascular providers performed at the level of the study’s 50 top performers, approximately 9,100 additional lives and $1.4 billion could be saved. More than 6,100 additional bypass and percutaneous coronary interventions (PCI) patients’ care could be complication-free.

LEARN MORE  


November 2016 Shifts in ALOS for Certain Surgical Procedures

As health systems transition from volume to value, a growing number of appendectomy, mastectomy, and thyroid procedures are shifting to outpatient facilities. However, when these procedures are performed as inpatient surgeries, patients’ average length of stay (ALOS) is increasing, implying that more severe cases are handled in hospitals, and likely will remain there. Hospitals should consider future demand and volume for these surgery services, capacity for an increase in hospital outpatient volume, and staffing and operational implications. 

LEARN MORE  


October 2016 Specialty Pharmacy Trends

The pharmacy benefit landscape today is complex and rapidly changing. One of the most significant drivers of pharmacy cost increases is the continued introduction of new specialty drugs into the marketplace. Worrisome trends, such as patent exclusivity, lack of high-quality alternatives, and lack of price regulation are making it critical for payers and employers—including large health systems—to better understand their specialty drug spend and find ways to combat the cost without reducing the quality of care.

LEARN MORE  


September 2016 Impact of Consumer-Directed Health Plans

Consumer-directed health plans are one of the fastest-growing benefit options for U.S. employees. A CDHP is a high-deductible preferred provider organization that is combined with either a health reimbursement arrangement or health savings account. Fund contributions are made by plan members or sponsors annually; unused amounts are typically carried over to the next plan year. Participants are encouraged to use decision-support tools to make more informed healthcare decisions and efficiently manage their fund. Truven Health Analytics conducted a study to provide employer and health plan decision-makers, and others in the healthcare industry, with key insights on the effectiveness of CDHPs in terms of multiyear cost, care, and utilization changes. 

LEARN MORE  


July/August 2016 Health System Performance

The Truven Health Anayltics 15 Top Health Systems study identifies U.S. health system leadership teams that have most effectively aligned outstanding performance across their organizations, and achieved more reliable outcomes in every member hospital. The  study measures relative balanced performance across a range of organizational key performance indicators including care quality, use of evidence-based medicine, post-discharge outcomes, operational efficiency, and patient perception of care. Just as evidence-based medicine is key to exceptional patient care, evidenced-based management is key to the well-being and success of health systems.

LEARN MORE  


June 2016 High- and Low Performing Hospitals | High-margin versus low-cost providers

The changing healthcare environment has put pressure on healthcare organizations to deliver top-quality care while keeping costs under control. Superior operational and financial performance can be measured by high margins and low costs. But there are significant operational indicators that differ between high- and low-performing hospitals, depending on whether performance is defined by expense or by margin. Often, hospitals with the lowest costs are considered the most successful. But low-cost hospitals do not necessarily behave the same way as hospitals with healthy margins. Low-cost hospitals can include both efficient hospitals and hospitals that are in dire financial circumstances that have forced them to even eliminate  expenses necessary for their long-term fiscal health.

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May 2016 Shifts in Cardiology Treatment

The shift from inpatient to outpatient care is increasing as hospitals transition from volume to value. A specific shift is seen in interventional cardiology treatment (cardiac catheterization, intracoronary stents, and percutaneous transluminal coronary angioplasties), which is moving from an inpatient hospital to outpatient hospital setting. Preliminary data show that most interventional cardiology procedures will soon be performed in the hospital outpatient setting. It will be important for hospitals to consider future demand and volume for interventional cardiology services; capacity for an increase in hospital outpatient volume; and staffing and operational implications. 

LEARN MORE  


April 2016 Hospital Performance

The annual Truven Health Analytics™ 100 Top Hospitals® identifies U.S. hospitals with the best overall performance across multiple organizational metrics, including clinical, operational, and financial. The ability of some hospitals to adapt as the industry is changing demonstrates leadership as the winners set the standards their peers seek to achieve. The study revealed that the nation's best hospitals had a lower mortality index, considering patient severity; had fewer patient complications; followed accepted care protocols; had lower 30-day mortality and 30-day readmission rates; sent patients home sooner; provided more timely emergency care; kept expenses low, both in-hospital and through the aftercare process; and scored better on patient surveys of hospital experience. 

LEARN MORE  


March 2016 Community Need and Preventable Hospitalizations

Truven Health Analytics™ evaluated the extent to which community need – a measure of the underlying economic and social factors that affect the overall health of a community, including income, cultural/language barriers, education, insurance and housing – is associated with elevated rates of preventable hospitalizations or an increased risk of hospitalization believed to be preventable with quality ambulatory care. The results of this investigation reveal a modest but statistically significant association between community need and an increased risk of hospitalizations that are believed to be preventable with good-quality ambulatory care.

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January/February 2016 AMI Trends: Incidence, Detection and Treatment

This Fact File examines trends in the detection and treatment of acute myocardial infarctions, or heart attacks, in two distinct groups: STEMI (coronary artery is completely blocked and cardiac muscle dies), and NSTEMI (coronary artery is partially blocked).

  • Overall rate of AMI continues to decrease.  For those patients where the coronary artery is completely blocked, improved awareness of coronary risk factors and related interventions appear to be associated with the decline. Those factors include patient lifestyle changes, use of statins, and elective interventions, such as percutaneous coronary intervention and coronary artery bypass grafting for patients at risk for AMI.
  • AMI-related deaths continue to decline. A number of factors are driving down hospital death rates, including emphasis on faster “door-to-balloon time” for angioplasty procedures; better education of the population to receive immediate medical attention for signs of AMI; improved emergency medical service protocols; provider adherence to best-practice guidelines for the treatment of AMI patients; and better coordination of services when transferring patients to hospitals with reperfusion/revascularization capabilities.
  • Percutaneous coronary intervention (PCI) varies by region. An increased use of PCI in certain areas could be due to practice pattern differences and regional efforts to improve access to PCI.

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December 2015 Cardiac Hospital Performance

The Truven Health Analytics 50 Top Cardiovascular Hospitals study identifies U.S. hospitals that have achieved the best performance on a balanced scorecard of performance measures. Based on comparisons between study winners and a peer group of similar hospitals that were not winners, winners are achieving better outcomes while operating more efficiently and at a lower cost. If all cardiovascular providers performed at the same level of this year’s winners, almost 8,000 additional lives could be saved; nearly 3,500 heart patients could be complication free; and more than $1.3 billion could be saved.

LEARN MORE  


November 2015 Inpatient Safety and Adverse Outcomes

The Agency for Healthcare Research and Quality’s Patient Safety Indicators (PSI) are a set of metrics that provide information on the potential for inpatient hospital complications and adverse events following surgeries, procedures, and childbirth. PSIs can be used to help hospitals identify potential adverse events that might need further evaluation, provide the opportunity to assess the incidence of adverse events and complications, and understand patient safety events on a broader level. In the United States in 2013, adverse outcomes were attributable to 2,176,763 additional days of stay, $8,011,500,131 in additional total hospital costs of care, and 14,315 potentially avoidable inpatient deaths.

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October 2015 Medicare Spend per Beneficiary

Medicare spend per beneficiary (MSPB) information is a Centers for Medicare & Medicaid Services metric that reflects the average cost of an episode of care for Medicare patients. This measure is important to consider as part of a hospital’s national balanced scorecard, as it reflects executives’ efforts to transform the healthcare delivery system and manage the full continuum of care, including the prominent shift from inpatient to outpatient utilization.

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September 2015 Efficient Purchasing and Performance

Spending on supplies and pharmaceutical services varies among U.S. hospitals. It is not uncommon for hospitals with similar types of patients, including case mix and severity, to have significant differences in purchasing intensity for certain clinical services. Even small changes in efficiency can make a difference for hospitals and health systems, because supply-chain spending typically accounts for hospitals’ biggest spend after labor costs. Costs totaled about $74 billion in 2012, according to the Healthcare Supply Chain Association.

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July-August 2015 Health System Achievers

The Truven Health 15 Top Health Systems®  study annually identifies those health system leadership teams that have most effectively aligned outstanding performance across their organizations, and achieved more reliable outcomes in every member hospital. Truven Health Analytics measures U.S. health systems based on a balanced scorecard across a range of performance factors: care quality, patient safety, use of evidence-based medicine, operational efficiency, and customer perception of care.

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June 2015 High and Low Bond Ratings

Healthcare organizations with strong bond ratings are regarded favorably from a financial perspective, of course. In addition, research by the Truven Health AnalyticsTM ActionOI® program shows that such organizations tend to excel in other categories, such as average length of stay and results of Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys.

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May 2015 Hospital Performance

The annual Truven Health 100 Top Hospitals® identifies U.S. hospitals with the best overall performance across multiple organizational metrics, including clinical, operational, and financial. The ability of some hospitals to adapt as the industry is changing demonstrates leadership as the winners set the standards their peers seek to achieve. Study projections indicate that if the new national benchmarks of high perfor¬mance were achieved by all hospitals in the United States, nearly 126,500 additional lives could be saved, almost 109,000 additional patients could be complication-free, and $1.8 billion in inpatient costs could be saved.

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April 2015 Drivers of Operating Margin

Some factors commonly used to explain poor operating performance do not prevent many hospitals from being highly profitable. For example, Truven Health Analytics has found that rates of uncompensated care, drug expense, and other factors do not seem to differ between unprofitable and very profitable hospitals. But factors such as Medicaid utilization rates and poor reimbursement rates do appear to impact the least profitable hospitals. One controllable factor that appears to be significant is labor productivity, with the most profitable hospitals posting the lowest labor expense per patient.

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March 2015 Community Need and Readmissions 

In response to concerns raised by healthcare leaders that the absence of adjustment for socioeconomic status (SES) and race characteristics in patient populations impedes the fair comparison of hospitals on risk-standardized 30-day unplanned readmission rates, Truven Health Analytics evaluated the extent to which risk-adjusted readmission rates for acute myocardial infarction, heart failure, and pneumonia are affected by adjustments for community-level SES factors through its Community Need Index (CNI) and patient race. The study shows there is, indeed, a statistically significant effect.

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January-February 2015 Trends in Health Insurance Costs

Healthcare reform regulations, increasing costs, and more competition are driving employers and their health plans to focus more than ever on opportunities to reduce cost trends. For example, the country experienced a 3.0% growth in per capita gross (allowed) medical and pharmacy costs from 2012 to 2013. Truven Health Analytics anticipates those costs in 2014 and 2015 will increase by 4% to 5% or more. By taking a data-driven approach, payers can manage costs and, ultimately, make their benefit programs sustainable in the context of healthcare reform. They can also maximize opportunities to improve population health and productivity and optimize the delivery of care.

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December 2014 Cardiac Hospital Performance

The Truven Health Analytics 50 Top Cardiovascular Hospitals study identifies hospitals that achieve the best performance on a scorecard of performance measures. This year, based on comparisons between the winners and a peer group of similar high-volume hospitals that were not winners, the study found that if all cardiovascular providers performed at the level of this year's winners, approximately 9,500 additional patients could survive, more than $1 billion could be saved, and almost 3,000 additional bypass and angioplasty patients could be complication-free. This is based on an analysis of Medicare patients; if the same standards were applied to all inpatients, the impact would be even greater.

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November 2014 Physician Enterprise Performance

As the healthcare industry continues to embrace the trend toward employed physicians, an external perspective and relevant benchmarks can be beneficial in assessing the comparative performance of your practices. While hospitals and health systems will continue to strategically acquire physician practices, individual hospital trends will not always document that growth because employed providers may be organizationally located in different companies, and the financials will not be shown as part of hospital operations. Still, the physician enterprise will represent a growing percentage of total operating expense for the integrated delivery system. Introducing greater efficiencies and improved productivity to the physician enterprise is critical to the financial health of the organization.

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October 2014 Impact of the So-Called 'Cadillac' Tax

The tax on high-cost health plans, which are often referred to as Cadillac plans, is expected to impact a considerable share of the plans provided by healthcare orga­nizations for their own employees, as much as 39% by 2020. The implications are significant because the excess-benefits tax requires the employer to pay 40% on the value of the portion of the plan that exceeds thresholds set by the Patient Protection and Affordable Care Act. Employers also need to consider that the tax is measured as a direct function of plan cost, and not actuarial plan value, and that a number of factors can drive excise-tax exposure.

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September 2014 Consumer Health Status

Healthcare providers can deliver much more effective care if they have an understanding of the characteristics, attitudes, and self-reported health status of a patient’s age group. By communicating effectively and delivering care in a manner that resonates with that particular group of patients, healthcare providers can strive to achieve better outcomes and higher patient satisfaction.

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July-August 2014 Hospital Financial Trends

The median fiscal and operational performance of U.S. hospitals over the past year remained relatively flat, despite expectations to the contrary. The data spans a four-year period from 2009Q4 to 2013Q4. Overall, hospitals saw flat or no growth in utilization, but major teaching hospitals saw steady utilization growth. Other notable trends include:

  • Outpatient charges are increasing as a percentage of total charges
  • Hospitals have been able to control margins by managing costs
  • Hospital margins have recovered since 2011 and have regained historic levels
  • 25% of all hospitals had negative margins
  • Hospitals control labor and supply expenses better than other operating expenses
  • All components of supply expense have been well-controlled
  • Average age of the plant continues to increase

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June 2014 Health System Performance

The Truven Health 15 Top Health Systems® in the United States outperform their peers by demonstrating balanced excellence—operating effectively across all functional areas of their organizations. Investigating the winner and nonwinner data from this study is a useful way to see how the nation’s health and the industry’s bottom lines could be improved. For apples-to-apples comparisons, the 15 Top Health Systems were placed into size categories by total operating expense: large (>$1.5 billion), medium ($750 million–$1.5 billion), and small (<$750 million).

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May 2014 Trends in Physician Demand

Truven Health Analytics research shows that physician productivity among those in Generation X (ages 34–49 in 2014) and the Millennial Generation (ages 18–33) is significantly less than the average productivity of retiring Baby Boomer physicians (ages 50–68). Replacing a Baby Boomer internist will require 1.6 younger physicians, while replacing a Baby Boomer pediatrician will require 2.0 younger physicians. Physician demand planning calls for staffing based on productivity, and organizations can’t assume that productivity will be the same from one physician to another. For this study, six markets that have different characteristics were selected from across the United States, including a range of city populations: San Francisco (825,863) and Sacramento (457,516) in California, which has highly managed payer and provider systems; Boston (636,479) in Massachusetts, where the legislature approved PPACA-like programs in 2006; Austin (842,592) and San Antonio (1,382,951) in Texas, which chose to not implement Medicaid expansion under PPACA; and Chicago (2,714,856) in Illinois, which chose to implement Medicaid expansion under PPACA.

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April 2014 100 Top Hospital Performance

The Truven Health AnalyticsTM 100 Top Hospitals® outperform their peers by demonstrating balanced excellence—operating effectively across all functional areas of their organizations. The data demonstrates how both patients’ health and hospitals’ bottom lines could be improved. Based on comparisons between the study winners and a peer group of similar high-volume hospitals that were not winners, the study found that if all hospitals performed at the level of this year’s winners, nearly 165,000 additional lives could be saved, more than 90,000 additional patients could be complication-free, $5.4 billion could be saved, and the typical patient could be released from the hospital half a day sooner.

LEARN MORE  


March 2014 Price Variation and Transparency

Recent changes to healthcare benefits, including the opportunity for consumers to exercise more choice in selecting providers and treatments, have the potential to help reduce costs. Truven Health Analytics has found that reducing price variation for the 108 million Americans with employer-sponsored insurance could save the nation as much as $36 billion per year. Providing consumers with clear, comparative information on the cost of services is key to further engaging them in decision-making and, ultimately, reducing healthcare costs. The data in this report demonstrate what could be saved through price transparency, with specific research on price variation in colonoscopies, a service that research has shown is particularly prone to price variation.

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January/February 2014 Outpatient Services Under PPACA

The Patient Protection and Affordable Care Act will affect the volume of outpatient procedures in all ambulatory care settings. With respect to Medicaid, not all states have opted in to that expansion under PPACA, but according to a Truven Health AnalyticsTM forecast, if all states do opt in to the expansion of Medicaid, the number of projected outpatient procedures (all payers) would be about 101 billion over the next 10 years, about 2 billion more than the number projected under the current environment (which accounts for states that have opted in or out). In this report, we’ll examine the implications for six states: Florida and Texas, which have opted out; and California, Illinois, Massachusetts, and Michigan, which have opted in.

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November 2013 Oncology Drug Trends

Cancer patients may have a different point of view on oncology drug decisions than non-patients, according to a survey conducted by Truven Health Analytics. Healthcare consumers were asked whether or not they agreed or disagreed with a recent decision by a large cancer center to not offer a new medication that has similiar benefits and side effects as an existing drug but it more costly. The fact that those who have experienced both the benefits and side effects of cancer drugs, and possibly out-of-pocket costs for these medications, may have more realistic attitudes towards cancer treatments.

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October 2013 Avoidable Emergency Department Usage

The inappropriate use of emergency department services is growing, resulting in care that is more costly and lacks continuity. The ability to measure the inappropriate use of these services is key to addressing this issue, but there has been little agreement on how to identify and categorize inappropriate ED visits. When the issue has been studied, the focus has been primarily on the Medicare, Medicaid, and uninsured populations. But people covered by private insurance are just as likely to overuse the ED.

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September 2013 Payment Integrity Analysis

The U.S. healthcare system is replete with waste. The key to avoiding waste in this area is meticulous attention to payment integrity issues. That is, making sure that the correct payment is made for the correct member for the correct service to the correct provider. For this study, Truven Health Analytics identified six payment integrity algorithms with the highest potential for savings. In addition to identifying potential waste, some of these algorithms have a clinical integrity dimension. Care that is wasteful or potentially fraudulent is also often of poor quality.

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July/August 2013 Hospital Financial Trends

The median fiscal and operational performance of U.S. hospitals over the past few years reveals some variation based on hospital type. The major teaching hospitals continue to have the greatest labor costs and net operating revenues, of course, but it is the medium community hospitals that demonstrated the best ability to keep labor costs in check since 2009 and also have shown the strongest net operating revenue gains. It is the small community hospitals, however, that have posted the biggest increases in operating margin figures over that period. Read the July/August 2013 Fact File on Hospital Financial Trends for this and more analysis from the recent study.

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June 2013 Hospital System Performance

The Truven Health 15 Top Health Systems® outperform their peers by demon­strating balanced excellence—operating effectively across all functional areas of their organizations. For example, the winning health systems performed better in quality and safety metrics, while also besting the non-winners in patient satisfaction as measured by HCAHPS. Such performance suggests that the winning systems will be well-positioned as the industry shifts to a pay-for-performance model. For apples-to-apples comparisons, systems were categorized by size based on total operating expense: large (> $1.5 billion), medium ($750 million–$1.5 billion), and small (<$750 million).

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May 2013 Hospital Employee Health Risk

Hospitals and health systems, as large employers, are feeling the burden of rising healthcare costs. In fact, hospital employee use of plan services is greater than that of the average U.S. employee. Hospital workers, on average, have higher utilization rates and carry a higher burden of chronic illness than employees in other market segments. These differences are only partially explained by age or gender. Hospital employee groups exhibit a skew toward a younger female population relative to the U.S. workforce; the average health system worker is two years younger than the average worker in the U.S. workforce. Truven Health AnalyticsTM researchers conclude that a health system with 16,000 eligible employees would save $1.5 million annually for each 1 percent reduction in health risk. Read the May 2013 Fact File on Hospital Employee Health Risk for this and more analysis from the recent study.

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April 2013 Hospital Performance

The Truven Health 100 Top Hospitals® outperform their peers by demonstrating balanced excellence — operating effectively across all functional areas of their organizations. The data demonstrates how patients' health and hospitals' bottom lines could be improved. Read the April 2013 Fact File on Hospital Performance for this and more analysis from the recent study.

LEARN MORE  


March 2013 Outpatient Trends

The combination of turbulence in the economy and changing models of care in the healthcare industry has had an impact over the past few years. As uncertainty wanes, there are some promising signs when it comes to outpatient trends, although there is notable variation based on specialty or procedure.

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January-February 2013 Consumer Sentiment

While there are some positive signs regarding consumers’ ability to pay for and use healthcare services, there are variations based on demographic factors such as age, education, and income. In addition, some provider services are experiencing growth, such as physician office visits, while others are seeing declines, such as hospital admissions for elective procedures.

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December 2012 Cardiovascular Hospital Performance

Comparing the 50 Top Cardiovascular Hospital award winners for 2013 to a peer group of hospitals, Truven Health AnalyticsTM found that if all cardiovascular providers performed at the level of the winners, nearly 8,600 additional lives and more than $1 billion could be saved. This is based on an analysis of Medicare patients; if the same standards were applied to all inpatients, the impact would be even greater.

LEARN MORE  


September 2012 Healthcare Attitudes

When it comes to elective procedures, consumer attitudes can vary considerably based on factors such as age, education, and income. Furthermore, the potential patient’s willingness to pay out of pocket is influenced by the procedure itself. For example, while only 18% of Americans earning less than $25,000 would be willing to pay up to $600 for alternative medicine treatment, 41% of that group would be willing to pay up to $400 for an ultrafast CT scan. In each of the procedures measured for this report, willingness to pay rose along with level of education.

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May 2017 Commercial Bundles

With premiums on the rise and commercial payers interested in increasing the value return on their healthcare investment, more payers are considering value-based care arrangements. While CMS has led the charge to use bundled payments for joint replacements through the Bundled Payments for Care Improvement (BPCI) and Comprehensive Care for Joint Replacement (CJR) program, there is increasing interest in these arrangements from the payer market. As payers and providers begin to anticipate and plan for the change, it’s important to study bundled payments from a variety of angles looking at cost variations by region, market, provider type, and payers.

LEARN MORE  


April 2017 Hospital Performance

Winners of the Truven Health Analytics™ 100 Top Hospitals® designation demonstrate how effective leaders manage change and achieve excellence in a dynamic environment. Using the measures presented in our National Balanced Scorecard, this year’s 100 Top Hospitals® study revealed significant differences between award winners and their nonwinning peers. The nation’s top-performing hospitals had lower inpatient mortality, considering patient severity; had fewer patient complications; followed accepted care protocols for stroke care and blood clot prevention; had lower 30-day mortality and 30-day readmission rates; sent patients home sooner; provided more timely emergency care; kept expenses lower, both in-hospital and through the aftercare process; and scored 10 points higher on patient ratings of their overall hospital experience.

LEARN MORE  


March 2017 Mental Health and Substance Abuse Treatment Trends

Behavioral health and substance abuse treatment costs are rising, along with demand for these services, driven in part by the opioid abuse epidemic. The Substance Abuse and Mental Health Services Administration projects that by 2020, mental health and substance abuse (MHSA) treatment spending will total $280.5 billion, a 63% increase from 2009.* Increasing utilization of substance abuse services reveals an opportunity to expand treatment and prevention programs in-house or through partnerships. In addition, hospitals and health systems can respond to these rising costs and greater need by ensuring opioid prescribing patterns meet current guidelines and by instituting care management assistance when pain medications are necessary.

LEARN MORE  


January/February 2017 30-Day Readmission Rates Cardiac Hospital Performance

The Truven Health Analytics™ study of 30-day readmission rates uses Medicare Hospital Compare data to analyze differences in readmission rates among hospitals across the nation. Aggressive efforts are being made by the Centers for Medicare & Medicaid Services, private health plans, and providers to reduce unplanned hospital readmissions. This study examines 30-day hospital readmission rates from 2011 to 2015. Rates of 30-day unplanned readmissions have improved consistently during the five-year period.

LEARN MORE  


December 2016 Cardiac Hospital Performance

Cardiovascular care affects hundreds of thousands of patients annually and adds billions of dollars to overall U.S. healthcare costs. The Truven Health 50 Top Cardiovascular Hospitals study uses a national scorecard of metrics to identify the nation’s highest-performing cardiovascular services lines. If all cardiovascular providers performed at the level of the study’s 50 top performers, approximately 9,100 additional lives and $1.4 billion could be saved. More than 6,100 additional bypass and percutaneous coronary interventions (PCI) patients’ care could be complication-free.

LEARN MORE  


November 2016 Shifts in ALOS for Certain Surgical Procedures

As health systems transition from volume to value, a growing number of appendectomy, mastectomy, and thyroid procedures are shifting to outpatient facilities. However, when these procedures are performed as inpatient surgeries, patients’ average length of stay (ALOS) is increasing, implying that more severe cases are handled in hospitals, and likely will remain there. Hospitals should consider future demand and volume for these surgery services, capacity for an increase in hospital outpatient volume, and staffing and operational implications. 

LEARN MORE  


October 2016 Specialty Pharmacy Trends

The pharmacy benefit landscape today is complex and rapidly changing. One of the most significant drivers of pharmacy cost increases is the continued introduction of new specialty drugs into the marketplace. Worrisome trends, such as patent exclusivity, lack of high-quality alternatives, and lack of price regulation are making it critical for payers and employers—including large health systems—to better understand their specialty drug spend and find ways to combat the cost without reducing the quality of care.

LEARN MORE  


September 2016 Impact of Consumer-Directed Health Plans

Consumer-directed health plans are one of the fastest-growing benefit options for U.S. employees. A CDHP is a high-deductible preferred provider organization that is combined with either a health reimbursement arrangement or health savings account. Fund contributions are made by plan members or sponsors annually; unused amounts are typically carried over to the next plan year. Participants are encouraged to use decision-support tools to make more informed healthcare decisions and efficiently manage their fund. Truven Health Analytics conducted a study to provide employer and health plan decision-makers, and others in the healthcare industry, with key insights on the effectiveness of CDHPs in terms of multiyear cost, care, and utilization changes. 

LEARN MORE  


July/August 2016 Health System Performance

The Truven Health Anayltics 15 Top Health Systems study identifies U.S. health system leadership teams that have most effectively aligned outstanding performance across their organizations, and achieved more reliable outcomes in every member hospital. The  study measures relative balanced performance across a range of organizational key performance indicators including care quality, use of evidence-based medicine, post-discharge outcomes, operational efficiency, and patient perception of care. Just as evidence-based medicine is key to exceptional patient care, evidenced-based management is key to the well-being and success of health systems.

LEARN MORE  


June 2016 High- and Low Performing Hospitals | High-margin versus low-cost providers

The changing healthcare environment has put pressure on healthcare organizations to deliver top-quality care while keeping costs under control. Superior operational and financial performance can be measured by high margins and low costs. But there are significant operational indicators that differ between high- and low-performing hospitals, depending on whether performance is defined by expense or by margin. Often, hospitals with the lowest costs are considered the most successful. But low-cost hospitals do not necessarily behave the same way as hospitals with healthy margins. Low-cost hospitals can include both efficient hospitals and hospitals that are in dire financial circumstances that have forced them to even eliminate  expenses necessary for their long-term fiscal health.

LEARN MORE  


May 2016 Shifts in Cardiology Treatment

The shift from inpatient to outpatient care is increasing as hospitals transition from volume to value. A specific shift is seen in interventional cardiology treatment (cardiac catheterization, intracoronary stents, and percutaneous transluminal coronary angioplasties), which is moving from an inpatient hospital to outpatient hospital setting. Preliminary data show that most interventional cardiology procedures will soon be performed in the hospital outpatient setting. It will be important for hospitals to consider future demand and volume for interventional cardiology services; capacity for an increase in hospital outpatient volume; and staffing and operational implications. 

LEARN MORE  


April 2016 Hospital Performance

The annual Truven Health Analytics™ 100 Top Hospitals® identifies U.S. hospitals with the best overall performance across multiple organizational metrics, including clinical, operational, and financial. The ability of some hospitals to adapt as the industry is changing demonstrates leadership as the winners set the standards their peers seek to achieve. The study revealed that the nation's best hospitals had a lower mortality index, considering patient severity; had fewer patient complications; followed accepted care protocols; had lower 30-day mortality and 30-day readmission rates; sent patients home sooner; provided more timely emergency care; kept expenses low, both in-hospital and through the aftercare process; and scored better on patient surveys of hospital experience. 

LEARN MORE  


March 2016 Community Need and Preventable Hospitalizations

Truven Health Analytics™ evaluated the extent to which community need – a measure of the underlying economic and social factors that affect the overall health of a community, including income, cultural/language barriers, education, insurance and housing – is associated with elevated rates of preventable hospitalizations or an increased risk of hospitalization believed to be preventable with quality ambulatory care. The results of this investigation reveal a modest but statistically significant association between community need and an increased risk of hospitalizations that are believed to be preventable with good-quality ambulatory care.

LEARN MORE  


January/February 2016 AMI Trends: Incidence, Detection and Treatment

This Fact File examines trends in the detection and treatment of acute myocardial infarctions, or heart attacks, in two distinct groups: STEMI (coronary artery is completely blocked and cardiac muscle dies), and NSTEMI (coronary artery is partially blocked).

  • Overall rate of AMI continues to decrease.  For those patients where the coronary artery is completely blocked, improved awareness of coronary risk factors and related interventions appear to be associated with the decline. Those factors include patient lifestyle changes, use of statins, and elective interventions, such as percutaneous coronary intervention and coronary artery bypass grafting for patients at risk for AMI.
  • AMI-related deaths continue to decline. A number of factors are driving down hospital death rates, including emphasis on faster “door-to-balloon time” for angioplasty procedures; better education of the population to receive immediate medical attention for signs of AMI; improved emergency medical service protocols; provider adherence to best-practice guidelines for the treatment of AMI patients; and better coordination of services when transferring patients to hospitals with reperfusion/revascularization capabilities.
  • Percutaneous coronary intervention (PCI) varies by region. An increased use of PCI in certain areas could be due to practice pattern differences and regional efforts to improve access to PCI.

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September 2015 Efficient Purchasing and Performance

Spending on supplies and pharmaceutical services varies among U.S. hospitals. It is not uncommon for hospitals with similar types of patients, including case mix and severity, to have significant differences in purchasing intensity for certain clinical services. Even small changes in efficiency can make a difference for hospitals and health systems, because supply-chain spending typically accounts for hospitals’ biggest spend after labor costs. Costs totaled about $74 billion in 2012, according to the Healthcare Supply Chain Association.

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July-August 2015 Health System Achievers

The Truven Health 15 Top Health Systems®  study annually identifies those health system leadership teams that have most effectively aligned outstanding performance across their organizations, and achieved more reliable outcomes in every member hospital. Truven Health Analytics measures U.S. health systems based on a balanced scorecard across a range of performance factors: care quality, patient safety, use of evidence-based medicine, operational efficiency, and customer perception of care.

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June 2015 High and Low Bond Ratings

Healthcare organizations with strong bond ratings are regarded favorably from a financial perspective, of course. In addition, research by the Truven Health AnalyticsTM ActionOI® program shows that such organizations tend to excel in other categories, such as average length of stay and results of Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys.

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May 2015 Hospital Performance

The annual Truven Health 100 Top Hospitals® identifies U.S. hospitals with the best overall performance across multiple organizational metrics, including clinical, operational, and financial. The ability of some hospitals to adapt as the industry is changing demonstrates leadership as the winners set the standards their peers seek to achieve. Study projections indicate that if the new national benchmarks of high perfor¬mance were achieved by all hospitals in the United States, nearly 126,500 additional lives could be saved, almost 109,000 additional patients could be complication-free, and $1.8 billion in inpatient costs could be saved.

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April 2015 Drivers of Operating Margin

Some factors commonly used to explain poor operating performance do not prevent many hospitals from being highly profitable. For example, Truven Health Analytics has found that rates of uncompensated care, drug expense, and other factors do not seem to differ between unprofitable and very profitable hospitals. But factors such as Medicaid utilization rates and poor reimbursement rates do appear to impact the least profitable hospitals. One controllable factor that appears to be significant is labor productivity, with the most profitable hospitals posting the lowest labor expense per patient.

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March 2015 Community Need and Readmissions 

In response to concerns raised by healthcare leaders that the absence of adjustment for socioeconomic status (SES) and race characteristics in patient populations impedes the fair comparison of hospitals on risk-standardized 30-day unplanned readmission rates, Truven Health Analytics evaluated the extent to which risk-adjusted readmission rates for acute myocardial infarction, heart failure, and pneumonia are affected by adjustments for community-level SES factors through its Community Need Index (CNI) and patient race. The study shows there is, indeed, a statistically significant effect.

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January-February 2015 Trends in Health Insurance Costs

Healthcare reform regulations, increasing costs, and more competition are driving employers and their health plans to focus more than ever on opportunities to reduce cost trends. For example, the country experienced a 3.0% growth in per capita gross (allowed) medical and pharmacy costs from 2012 to 2013. Truven Health Analytics anticipates those costs in 2014 and 2015 will increase by 4% to 5% or more. By taking a data-driven approach, payers can manage costs and, ultimately, make their benefit programs sustainable in the context of healthcare reform. They can also maximize opportunities to improve population health and productivity and optimize the delivery of care.

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December 2014 Cardiac Hospital Performance

The Truven Health Analytics 50 Top Cardiovascular Hospitals study identifies hospitals that achieve the best performance on a scorecard of performance measures. This year, based on comparisons between the winners and a peer group of similar high-volume hospitals that were not winners, the study found that if all cardiovascular providers performed at the level of this year's winners, approximately 9,500 additional patients could survive, more than $1 billion could be saved, and almost 3,000 additional bypass and angioplasty patients could be complication-free. This is based on an analysis of Medicare patients; if the same standards were applied to all inpatients, the impact would be even greater.

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November 2014 Physician Enterprise Performance

As the healthcare industry continues to embrace the trend toward employed physicians, an external perspective and relevant benchmarks can be beneficial in assessing the comparative performance of your practices. While hospitals and health systems will continue to strategically acquire physician practices, individual hospital trends will not always document that growth because employed providers may be organizationally located in different companies, and the financials will not be shown as part of hospital operations. Still, the physician enterprise will represent a growing percentage of total operating expense for the integrated delivery system. Introducing greater efficiencies and improved productivity to the physician enterprise is critical to the financial health of the organization.

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October 2014 Impact of the So-Called 'Cadillac' Tax

The tax on high-cost health plans, which are often referred to as Cadillac plans, is expected to impact a considerable share of the plans provided by healthcare orga­nizations for their own employees, as much as 39% by 2020. The implications are significant because the excess-benefits tax requires the employer to pay 40% on the value of the portion of the plan that exceeds thresholds set by the Patient Protection and Affordable Care Act. Employers also need to consider that the tax is measured as a direct function of plan cost, and not actuarial plan value, and that a number of factors can drive excise-tax exposure.

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September 2014 Consumer Health Status

Healthcare providers can deliver much more effective care if they have an understanding of the characteristics, attitudes, and self-reported health status of a patient’s age group. By communicating effectively and delivering care in a manner that resonates with that particular group of patients, healthcare providers can strive to achieve better outcomes and higher patient satisfaction. 

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July-August 2014 Hospital Financial Trends

The median fiscal and operational performance of U.S. hospitals over the past year remained relatively flat, despite expectations to the contrary. The data spans a four-year period from 2009Q4 to 2013Q4. Overall, hospitals saw flat or no growth in utilization, but major teaching hospitals saw steady utilization growth. Other notable trends include:

  • Outpatient charges are increasing as a percentage of total charges
  • Hospitals have been able to control margins by managing costs
  • Hospital margins have recovered since 2011 and have regained historic levels
  • 25% of all hospitals had negative margins
  • Hospitals control labor and supply expenses better than other operating expenses
  • All components of supply expense have been well-controlled
  • Average age of the plant continues to increase

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June 2014 Health System Performance

The Truven Health 15 Top Health Systems® in the United States outperform their peers by demonstrating balanced excellence—operating effectively across all functional areas of their organizations. Investigating the winner and nonwinner data from this study is a useful way to see how the nation’s health and the industry’s bottom lines could be improved. For apples-to-apples comparisons, the 15 Top Health Systems were placed into size categories by total operating expense: large (>$1.5 billion), medium ($750 million–$1.5 billion), and small (<$750 million).

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May 2014 Trends in Physician Demand

Truven Health Analytics research shows that physician productivity among those in Generation X (ages 34–49 in 2014) and the Millennial Generation (ages 18–33) is significantly less than the average productivity of retiring Baby Boomer physicians (ages 50–68). Replacing a Baby Boomer internist will require 1.6 younger physicians, while replacing a Baby Boomer pediatrician will require 2.0 younger physicians. Physician demand planning calls for staffing based on productivity, and organizations can’t assume that productivity will be the same from one physician to another. For this study, six markets that have different characteristics were selected from across the United States, including a range of city populations: San Francisco (825,863) and Sacramento (457,516) in California, which has highly managed payer and provider systems; Boston (636,479) in Massachusetts, where the legislature approved PPACA-like programs in 2006; Austin (842,592) and San Antonio (1,382,951) in Texas, which chose to not implement Medicaid expansion under PPACA; and Chicago (2,714,856) in Illinois, which chose to implement Medicaid expansion under PPACA.

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April 2014 100 Top Hospital Performance

The Truven Health AnalyticsTM 100 Top Hospitals® outperform their peers by demonstrating balanced excellence—operating effectively across all functional areas of their organizations. The data demonstrates how both patients’ health and hospitals’ bottom lines could be improved. Based on comparisons between the study winners and a peer group of similar high-volume hospitals that were not winners, the study found that if all hospitals performed at the level of this year’s winners, nearly 165,000 additional lives could be saved, more than 90,000 additional patients could be complication-free, $5.4 billion could be saved, and the typical patient could be released from the hospital half a day sooner. 

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March 2014 Price Variation and Transparency

Recent changes to healthcare benefits, including the opportunity for consumers to exercise more choice in selecting providers and treatments, have the potential to help reduce costs. Truven Health Analytics has found that reducing price variation for the 108 million Americans with employer-sponsored insurance could save the nation as much as $36 billion per year. Providing consumers with clear, comparative information on the cost of services is key to further engaging them in decision-making and, ultimately, reducing healthcare costs. The data in this report demonstrate what could be saved through price transparency, with specific research on price variation in colonoscopies, a service that research has shown is particularly prone to price variation.

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January/February 2014 Outpatient Services Under PPACA

The Patient Protection and Affordable Care Act will affect the volume of outpatient procedures in all ambulatory care settings. With respect to Medicaid, not all states have opted in to that expansion under PPACA, but according to a Truven Health AnalyticsTM forecast, if all states do opt in to the expansion of Medicaid, the number of projected outpatient procedures (all payers) would be about 101 billion over the next 10 years, about 2 billion more than the number projected under the current environment (which accounts for states that have opted in or out). In this report, we’ll examine the implications for six states: Florida and Texas, which have opted out; and California, Illinois, Massachusetts, and Michigan, which have opted in.

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November 2013 Oncology Drug Trends

Cancer patients may have a different point of view on oncology drug decisions than non-patients, according to a survey conducted by Truven Health Analytics. Healthcare consumers were asked whether or not they agreed or disagreed with a recent decision by a large cancer center to not offer a new medication that has similiar benefits and side effects as an existing drug but it more costly. The fact that those who have experienced both the benefits and side effects of cancer drugs, and possibly out-of-pocket costs for these medications, may have more realistic attitudes towards cancer treatments.

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October 2013 Avoidable Emergency Department Usage

The inappropriate use of emergency department services is growing, resulting in care that is more costly and lacks continuity. The ability to measure the inappropriate use of these services is key to addressing this issue, but there has been little agreement on how to identify and categorize inappropriate ED visits. When the issue has been studied, the focus has been primarily on the Medicare, Medicaid, and uninsured populations. But people covered by private insurance are just as likely to overuse the ED.

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September 2013 Payment Integrity Analysis

The U.S. healthcare system is replete with waste. The key to avoiding waste in this area is meticulous attention to payment integrity issues. That is, making sure that the correct payment is made for the correct member for the correct service to the correct provider. For this study, Truven Health Analytics identified six payment integrity algorithms with the highest potential for savings. In addition to identifying potential waste, some of these algorithms have a clinical integrity dimension. Care that is wasteful or potentially fraudulent is also often of poor quality.

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July/August 2013 Hospital Financial Trends

The median fiscal and operational performance of U.S. hospitals over the past few years reveals some variation based on hospital type. The major teaching hospitals continue to have the greatest labor costs and net operating revenues, of course, but it is the medium community hospitals that demonstrated the best ability to keep labor costs in check since 2009 and also have shown the strongest net operating revenue gains. It is the small community hospitals, however, that have posted the biggest increases in operating margin figures over that period. Read the July/August 2013 Fact File on Hospital Financial Trends for this and more analysis from the recent study.

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June 2013 Hospital System Performance

The Truven Health 15 Top Health Systems® outperform their peers by demon­strating balanced excellence—operating effectively across all functional areas of their organizations. For example, the winning health systems performed better in quality and safety metrics, while also besting the non-winners in patient satisfaction as measured by HCAHPS. Such performance suggests that the winning systems will be well-positioned as the industry shifts to a pay-for-performance model. For apples-to-apples comparisons, systems were categorized by size based on total operating expense: large (> $1.5 billion), medium ($750 million–$1.5 billion), and small (<$750 million).

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May 2013 Hospital Employee Health Risk

Hospitals and health systems, as large employers, are feeling the burden of rising healthcare costs. In fact, hospital employee use of plan services is greater than that of the average U.S. employee. Hospital workers, on average, have higher utilization rates and carry a higher burden of chronic illness than employees in other market segments. These differences are only partially explained by age or gender. Hospital employee groups exhibit a skew toward a younger female population relative to the U.S. workforce; the average health system worker is two years younger than the average worker in the U.S. workforce. Truven Health AnalyticsTM researchers conclude that a health system with 16,000 eligible employees would save $1.5 million annually for each 1 percent reduction in health risk. Read the May 2013 Fact File on Hospital Employee Health Risk for this and more analysis from the recent study.

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April 2013 Hospital Performance

The Truven Health 100 Top Hospitals® outperform their peers by demonstrating balanced excellence — operating effectively across all functional areas of their organizations. The data demonstrates how patients' health and hospitals' bottom lines could be improved. Read the April 2013 Fact File on Hospital Performance for this and more analysis from the recent study.

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March 2013 Outpatient Trends

The combination of turbulence in the economy and changing models of care in the healthcare industry has had an impact over the past few years. As uncertainty wanes, there are some promising signs when it comes to outpatient trends, although there is notable variation based on specialty or procedure.

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January-February 2013 Consumer Sentiment

While there are some positive signs regarding consumers’ ability to pay for and use healthcare services, there are variations based on demographic factors such as age, education, and income. In addition, some provider services are experiencing growth, such as physician office visits, while others are seeing declines, such as hospital admissions for elective procedures.

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December 2012 Cardiovascular Hospital Performance

Comparing the 50 Top Cardiovascular Hospital award winners for 2013 to a peer group of hospitals, Truven Health AnalyticsTM found that if all cardiovascular providers performed at the level of the winners, nearly 8,600 additional lives and more than $1 billion could be saved. This is based on an analysis of Medicare patients; if the same standards were applied to all inpatients, the impact would be even greater.

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September 2012 Healthcare Attitudes

When it comes to elective procedures, consumer attitudes can vary considerably based on factors such as age, education, and income. Furthermore, the potential patient’s willingness to pay out of pocket is influenced by the procedure itself. For example, while only 18% of Americans earning less than $25,000 would be willing to pay up to $600 for alternative medicine treatment, 41% of that group would be willing to pay up to $400 for an ultrafast CT scan. In each of the procedures measured for this report, willingness to pay rose along with level of education.

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