Health Insurance Exchange | Planning and Implementation image

Health Insurance Exchanges

Since the Affordable Care Act introduced the concept of an online marketplace — where individuals and small employers can shop and compare insurance options — health insurance exchanges have begun to evolve and take shape.

At Truven Health Analytics, we can partner with you to navigate this fast moving and dynamic environment, whether you’re a State setting up a public exchange or partnering with the Federal government, a third-party involved in the creation of a private exchange, or a health plan deciding how to participate.

As an objective, trusted partner, we provide actionable insights to support multiple aspects of planning and implementation, including:

  • Consumer Engagement
  • Planning and Go-to-Market Strategies
  • Risk Adjustment and Reinsurance
  • Cost-Sharing Reduction Analysis and Reconciliation
  • Performance Measures
  • Data Warehousing and Analytics

Measure your preparedness with our Exchange Readiness Checklist.

Consumer Engagement: The Key to a Successful Exchange

Provide consumers moving onto your exchange with the tools they’ll need to make informed healthcare decisions, including:

  • An easy way to model and compare benefit plan designs, and determine the actual cost of coverage
  • An electronic calculator that provides out-of-pocket cost estimates for anticipated services and procedures
  • A multi-channel personalized messaging solution to help consumers proactively manage their health

Truven Health Analytics provides a suite of web-based tools to help consumers understand their benefit options. By incorporating these tools into your exchange website, you’ll ensure consumers are well informed and actively engaged in managing their care.

Planning and Go-to-Market Strategies

Make informed decisions about the design of your exchange with comprehensive, detailed profiles of the estimated 25 million individuals who will gain coverage through exchanges and Medicaid expansion. Truven Health Analytics offers highly relevant, actionable insights into the size and makeup of the newly insured population, including year-by-year coverage through 2020. In addition, we offer detailed profiles of their health, wellness, attitudes, and service utilization at a granular geographic level.

Risk Adjustment and Reinsurance

Meet the demands of the Affordable Care Act's Reinsurance, Risk Corridor, and Risk Adjustment programs with our edge server solutions. We serve as the data and information foundation for risk adjustment and reinsurance payment programs by aggregating claims and eligibility data from exchange participants and applying our approved risk adjustment methods. We then feed the relevant, appropriate information required to the reinsurance program for effective administration.

Cost-Sharing Reduction Analysis and Reconciliation

Reduce the administrative burden of complying with the cost-sharing reduction program requirements. The Truven Health cost-sharing reduction analysis and reconciliation solution helps you accurately forecast cost-sharing exposures, validate payments to eligible members, and reconcile year-end results. Click here to review the results of our survey of health plans and their cost-sharing reduction activity.

Performance Measures

Improve the performance of your exchange with accurate, timely analysis of coverage data and other key performance measures. At Truven Health Analytics, we help you evaluate your performance and meet the requirements for transparency and standardized public data reporting.

Data Warehousing and Advanced Analytics

Support decision making with a single source of truth. At Truven Health Analytics, we have extensive experience aggregating claims, eligibility, and clinical data from diverse sources into a single integrated database. In addition, we have a proven ability to apply sound analytic methodologies to that data.