The Truven Health Blog

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The Next Chapter of Enterprise Analytics for Payers Part 3 - What is Your Enterprise Analytics Roadmap?

Thursday, October 5, 2017

This excerpt originally appeared as a post on the Read part two.

Payers can deploy advanced analytics on top of their EDWs to enable reliable, faster decision making across the organization, and to enhance the value analytics teams can deliver. But with numerous business intelligence needs and stakeholders, prioritizing can be challenging.

We recommend the following four-step approach:

Align Analytics Initiatives with Business Priorities

Begin by identifying the strategic initiatives and business activities that could be most positively impacted by enhanced analytic insights. Some questions to consider include:

  • What are the key business imperatives?
  • Where can the greatest impact be made with support from advanced analytics?
  • Which business functions and stakeholders
  • require more timely information?

Identify the Analytics Required to Meet the Business Needs

With specific business priorities in mind, the next step is to determine what analytics are needed and how they’ll be visualized. You’ll want to assess the current suite of analytic tools and capabilities employed to address stakeholder needs including:

  • Grouping methodologies
  • Risk and severity models
  • Clinical rules
  • Reference data

Determine the Timeliness of Reporting Needs

As advanced analytics are selected for the analytic environment, payers should also evaluate their fit with existing business intelligence tools and capabilities. A few questions analytics leaders can ask to get started include:

  • Are analytic data marts easily accessible to analytics teams?
  • How current will the data need to be for various business reporting subject areas?
  • Would a conformed dimensional warehouse model speed user analysis and allow root cause to be evaluated?

Monitor and Adjust

Implementing a comprehensive EDW and advanced analytics strategy will likely be an iterative undertaking. That’s why it’s important to view your EDW and analytics initiatives as an ongoing process that doesn’t need to be perfect to get started. Regardless of where you are in the EDW-analytics journey, you’ll want to designate time quarterly or bi-annually to revisit the analytics roadmap and evaluate whether needs have changed.

In today's complex healthcare landscape, the path to success for payers will likely require a greater reliance on enterprise data and the critical insights that can be derived from that data. Licensing proven analytics that can be layered on top of the EDW can help accelerate time to insight. Click here to learn more about our new solution, Flexible Analytics.

The Next Chapter of Enterprise Analytics for Payers Part 2 - Is your data ready for advanced analytics?

Thursday, October 5, 2017

This excerpt originally appeared as a post on the . Read part one.

Healthcare Payers today can increasingly leverage proven, off-the-shelf methodologies in their own technology environments to help accelerate business insights and transformation.

Completeness Checks

An audit, balance and control (ABC) framework should be in place to identify and limit the impact of missing data, and you’ll want to determine acceptable thresholds when data is missing. Establishing these thresholds and benchmarks by field will focus the data warehouse team on areas that need further improvement, as well as allow users to contemplate the impact incomplete data could have on their analytics and reporting.

Validity Checks

It’s important to conduct validity checks on fields that should contain standard codes or elements, and compare recorded values to lists of possible valid values for that field. When these validity checks flag unexpected values, you can establish the validity of the nonconforming code. If new values have been added to the coding scheme, it might be necessary to update of the conversion program or code lists.

Reasonableness Checks

Consider conducting reasonableness checks to ensure the data makes sense. For example, look at the relationship between two or more related columns, or between a column and benchmark data, to confirm they are reasonable. Examples of reasonableness checks include ratio of surgical services to total services, percentage of non-specific diagnosis codes, and ranges of average cost per service by procedure code.

Click here to read part three of the blog series, which explores how payers can develop their enterprise analytics roadmap to help them prioritize and roll out analytic resources and initiatives across the business.

The Next Chapter of Enterprise Analytics for Payers Part 1: How Mature is your Enterprise Data Warehouse?

Thursday, October 5, 2017

This excerpt originally appeared as a post on the Read the intro.

In the introduction to this 3-part blog series, we discussed how a new approach to enterprise analytics can help payers accelerate business value and transformation by leveraging proven, off-the-shelf methodologies.

There is only one

A data warehouse is an EDW if it holds all your information and makes it available for various stakeholders across your company. If there are other data warehouses in use for reporting that have overlapping subject matter or additional information not in or derived from the EDW, then analytics and reports may be generated that differ or compete with one another.

Maturity goal: A single EDW that holds all the business information necessary to support team members.

Latency and freshness

The timeliness of analytic data should meet the needs of your business operations. If your users need a daily report of patients who are being admitted or discharged from the hospital, a weekly refresh of your EDW will not meet the business expectation. Not all situations require real-time data latency, but nearly all situations require consistent and dependable data refreshes.

Maturity goal: An EDW with data refreshed on a frequency that aligns with your business operations.

Data mart strategy

Various project teams will need different views of the same data to answer specific business questions. Though it's critical for the underlying data and definitions to be consistent, the questions that are asked by different stakeholder groups will vary. If your end users are building their own copies of your data to fit their needs, then your EDW maturity level may be low. 

Maturity goal: An EDW that allows stakeholder groups to customize views, rather than making copies of your data.

Usability and training

Users should be able to navigate the domains of your EDW easily after training and online guidance. If more than 80 percent of new query and report needs are completed by users without a call for assistance or a support ticket, your EDW is considered mature.

Maturity goal: An easy-to-use EDW that enables users with basic training.

Governance and growth

Another aspect of EDW maturity is its ability to handle change and adapt accordingly. If project teams feel like it is too much work to create new domains or implement changes, your EDW strategy and solution may be at risk.

Maturity goal: An EDW that can scale as your business needs evolve.

Click here to read part two of the blog series, which explores three types of data quality checks payers can implement to advance their data management practices and analytics initiatives.

The Next Chapter of Enterprise Analytics for Healthcare Payers

Thursday, October 5, 2017

This excerpt originally appeared as a post on the

Healthcare payers today are facing a changing healthcare marketplace that demands business model transformation and the redesign of operational processes. In this new paradigm, information-centric strategies that support data-driven decision-making across the enterprise can help payers compete.

In many cases, payers have the data they need, but they might struggle to analyze it. Existing analytics strategies that may be falling short include:

    Building and maintaining analytics in-house, which can consume valuable time and resources.

    Deploying a best-of-breed approach, which can require health plans to piece together disparate methodologies licensed from multiple vendors, often leading to disconnected data and analytic context.

    Outsourcing data analytics, which can limit payers' ability to choose which analytics to run and when.

To help drive business transformation, payer technology and analytics leaders can increasingly leverage proven analytics in their own technology environments. This is an approach that can not only accelerate time to value, but can also help meet the reporting needs and requirements of business operations.

Click here to read part one of this series, which explores the measurable characteristics payer technology leaders can use to assess their EDW maturity and identify opportunities for improvement.

The 2016 Cost-Sharing Reduction Reconciliation Submission Deadline Has Passed – Are You Ready for Next Year?

Monday, June 5, 2017

Under the Affordable Care Act (ACA), issuers of qualified health plans must offer cost-sharing variations of their plans, to provide options with reduced out-of-pocket expenses to eligible enrollees. The Centers for Medicare & Medicaid Services (CMS) advances funds to insurers monthly during the benefit year to offset these costs, followed by the requisite annual reconciliation.

Now that the June 2nd deadline for submitting 2016 cost-sharing reduction (CSR) reconciliations has passed, it’s important for health plans to evaluate their submission processes and decide whether they’ll need help reconciling subsidies for 2017.

Though it is unclear whether subsidies will continue -- given the uncertainty of healthcare reform and the push to eliminate the program -- America’s Health Insurance Plans (AHIP), the American Medical Association, the American Hospital Association, and a number of other business and healthcare organizations support continuing the program. In fact, several issued a calling for at least a two-year commitment to funding ACA CSR payments, and they want to see the money included in a congressional spending bill. As of this writing, CMS continues to provide CSR payments to health plans, and plans will be required to reconcile payments at the close of the 2017 benefit year.

Why you should start planning now for 2017

The CSR requirements are integral to the affordability of individual plans on the federally facilitated state marketplaces (the Marketplace), and essential for an issuer’s ability to control plan premiums. It’s vital for health plans to ensure that their advanced payments are reconciled accurately.  The law requires that health plans:

  • Utilize the Standard method (re-adjudication of 100 percent of claims) for the 2017 benefit year (as opposed to the earlier Simplified option)
  • Reconcile all advance payments and actual subsidies at the end of the year

In addition to being a complex compliance task, CSR reconciliation also carries much financial risk. According to CMS, more than half of enrollees in plans sold in the Marketplace choose CSR plans,* which means there could be a significant financial impact on health plans if subsidies aren’t reported correctly. Health plans need to reconcile accurately to be assured they receive any additional funds CMS may owe them or to return funds to CMS if their expenses were less than projected.

Health plans: If you struggled with your 2016 submissions or are worried about implementing the now-required Standard method for 2017, it’s time to select a partner for this task. Implementing the more complicated Standard method takes time, and there’s too much money at stake to be anything less than fully prepared and compliant. Contact us today for more information.

Marie Bowker, Senior Client Executive
Bryan Briegel, Healthcare Reform Solutions Strategist

* Centers for Medicare and Medicaid Services, “March 31, 2016 Effectuated Enrollment Snapshot” (CMS, June 30, 2016).

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