Solutions For. Information, Insights, and Analysis to Help Manage Business Challenges

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1 Solutions For Health Plans Information, Insights, and Analysis to Help Manage Business Challenges

2 Solutions for Health Plans Health plans are challenged with controlling medical costs, engaging members in healthcare decisions, and responding to increased government regulations. As your partner, Truven Health Analytics will work with you to uncover key insights to improve member health and manage costs. We ll integrate your disparate data sources with our benchmarks and apply proven clinical and analytic methods giving you the information you need to attain differentiation and achieve corporate growth. The Next Era of Healthcare Are You Ready to Lead? Today, health plan executives have an unprecedented opportunity to evolve their business model from transaction manager to strategic healthcare partner. In the process, they can improve their brand image, community standing, quality of care, and cost structure. Advancing business intelligence and a historic transformation of the healthcare marketplace have created an opportunity for leaders in the industry to act now. In this era of accountability, payers are increasingly challenged to make information transparent to employers, physicians, consumers, and the government. The health plans that thrive in this new era are embracing new quality imperatives, engaging members and physicians in collaborative relationships, turning to a holistic approach to care management, and meeting customer demands for service and value. Change creates opportunity, and there has never been a better time for your plan to take a leadership role. A Proven Partner For more than 30 years, Truven Health has partnered with our customers to provide independent information and analysis to help manage business challenges. As our partner, you ll benefit from an intimate understanding of healthcare information and a passion for helping you succeed that no other vendor can match. We offer: Market-leading analytic methodologies that industry professionals confidently rely on to improve the quality and efficiency of care. A unique healthcare measures catalog that codifies more than 1,800 standardized measures saving analyst time and providing a consistent point of reference across the entire organization. 1

3 The most highly qualified staff in the industry, including professionals with PhDs, MDs, and master s degrees in public health, public administration, nursing, and epidemiology. World-class normative benchmarks reflecting the nuances and diversity of today s healthcare system helping improve reliability. Decision support and analytic experience across the full spectrum of the healthcare industry, including leading employers who provide us with unique insights into the needs of your customers. A comprehensive, powerful, and flexible solution for payment integrity services for health plans. Our expert services from identification and prevention to investigation and recovery are designed to help you fight fraud, waste, and abuse. HIGHLIGHTS Better plan design Proactive care management Responsive customer reporting Transparent provider performance measurement Fair pay-for-performance initiatives Fraud and abuse detection services for health plans 2

4 Truven Health Analytics Solutions and Services Health Plan Solutions From Truven Health Analytics Truven Health Solutions and Services Enterprise Decision Support Employer Group Reporting Consumer Solutions Care Management Analytics Analytic Consulting Performance and Quality Measurement Analytics/ Measures Norms and Benchmarking Marketing Analytics/ Consulting HEDIS Provider Risk Scoring and Credentialing Fraud and Abuse Prepay and Postpay Audit and Compliance Predictive Modeling Data Management Product Design and Development Actuarial Underwriting and Finance Special Investigations Unit Sales and Marketing Health Plan Stakeholders Claims and Other Administrative Provider and Network Management IT and Informatics Care Management (CM, DM, Health and Wellness) Consumer Decision Support Pharmacy Management Customer Member Services 2013 Truven Health Analytics Inc. All rights reserved. All other product names used herein are trademarks of their respective owners. HP Health Plan Stakeholders Truven Health Core Business Model STAGE 1 STAGE 2 STAGE 3 STAGE 4 STAGE 5! Data Collection Data Transformation Intelligence Building Application Delivery Knowledge Management Membership Provider Privacy Protection Standardization Proprietary Methods and Algorithms Trend Analysis Pay for Performance Medical/Rx Claims Customization Episodes of Care Provider Profiling Actionable Analytics Dental/Vision Care Management System Disease Management Enhancement Quality Assurance Quality Improvement Integration Performance Measures Disease Staging Norms/Benchmarks Employer Insights Fraud and Abuse Clinical Measurement Predictive Modeling Consulting Customer Training Proactive Support Vendor Disease Management Lab Results Health and Wellness Health Risk Appraisal Program Evaluation Personal Health Record Other Health Data MarketScan De-Identified, Enhanced Data Consumer Advantage Solutions

5 Drive Efficiency and Control Costs In these times of dramatic change, Truven Health information solutions help health plans develop a competitive cost and quality advantage. Our decision support products organize healthcare information from diverse sources and systems to support enterprise-wide decision making. They are designed to provide advanced healthcare analysis for: Better Business Decisions With the leading healthcare data warehouse solution and a one-of-a-kind healthcare measures catalog, we can drive faster, more efficient, and better quality decisions across all core areas of your organization and develop reports to share data with internal and external stakeholders. Care Management Our care management analytic solutions and services enable you to tailor interventions to improve patient compliance and health outcomes. Predictive modeling and our episodebased clinical measures let you more accurately measure, predict, and manage risk. Comparative standards and best-in-class benchmarking help you identify and focus interventions to maximize ROI. Provider Initiatives Truven Health has proven we can facilitate successful partnerships to improve patient care while reducing overall costs. We help you improve performance by monitoring physician practice patterns with risk- and severity-adjusted measures. Only Truven Health offers risk-adjusted, disease-based episodes that take into account co-morbidities for fair physician evaluation. Actuarial and Underwriting Actuaries use our risk-profiling solutions and predictive modeling applications in their pricing models for a more comprehensive understanding of risk. Consumer Engagement Truven Health offers consumer decision support tools to benefit both payers and consumers. We leverage valuable information about individuals healthcare attitudes and behaviors and apply the combined data assets, analytics, and program assessment to create healthcare decision support tools for consumers. Payment Integrity With more than two decades of fraud, waste, and abuse experience, Truven Health is well-positioned to help you exceed these requirements while lowering internal costs and demonstrating a double-digit ROI. Develop a competitive cost and quality advantage. Our products and services have assisted more than 25 Medicaid agencies and the federal government in identifying millions of dollars in healthcare fraud, waste, and abuse. Experience in the government sector has provided us a robust framework that is now being used by commercial plans and managed care organizations to stop abusive billing practices. 4

6 Expand Your Relationships and Grow Your Top Line The unsustainable increases in costs and the desire to consolidate vendors have changed how employers and brokers regard health plans expectations have increased. To deliver, health plans must not only respond quickly to information demands, but also add value by providing innovative ideas. Truven Health offers health plans a data and application platform that meets the challenging demands for information from employers and business partners. Our independent benchmarks enable you to demonstrate your effectiveness relative to the performance of your peers. Using a single, integrated, and analytically ready data warehouse along with our web-based reporting, you ll have a flexible and scalable solution to meet your needs. Our healthcare solutions provide your team with expert insight and an informed view of your strategic direction, empowering health plans with a significant competitive advantage through: Direct online access to analytic reports that explain changes in costs and utilization while uncovering savings opportunities Consulting services offering knowledge and expertise in benefits planning Sophisticated information filters to identify early warning signs of emerging trends Benefit plan models that help you develop customized options for your covered population New information-based programs, such as pay-for-performance and consumer-driven health plans, that enable employers to leverage quality providers and create greater accountability with consumers Program assessments that demonstrate the effectiveness of care management programs and provider networks Truven Health Information Solutions and Analyses Provide Key Insights Our health plan solutions are comprehensive, intuitive, and usability tested. They help drive more effective analysis through data exploration and custom reporting applications from simple ad hoc reports to executive-level dashboards. We have a wide range of solutions to help you increase revenue and improve your bottom line enterprise-wide. Truven Health Advantage Suite is a web-based decision support solution that streamlines and improves decision-making through its powerful applications. By integrating and standardizing information from disparate sources, Advantage Suite gives you a competitive edge in managing costs and quality. Analysts and managers can access reports, dashboards, and administrative applications from a central location improving efficiency and effectiveness. Plus, reports can be easily tailored to your information needs and quickly distributed in presentation-ready format. Truven Health Employer Insights offers health plans and third-party administrators financial and clinical information to manage costs; improve quality; set pricing and account management strategies; and furnish reliable, accurate, timely information to key customers. 5

7 Truven Health Consumer Advantage solutions including Treatment Cost Calculator, Personalized Messaging, and Personal Health Insights help members become engaged consumers who take greater ownership of their own health and wellness by offering them personalized, relevant decision support tools. Truven Health Data Management solutions take disparate data medical claims and non-medical claims data such as pharmacy benefit management, lab, health risk assessment, disability, dental, and vision from various vendors and organize it into a standard format, helping you achieve your information management goals and freeing up your resources to focus on other opportunities and missioncritical issues. Truven Health Market Expert integrates proprietary databases, customer data, and public information into a powerful market and consumer analysis tool. Truven Health MarketScan Databases are an independent source of efficiency and effectiveness benchmarks based on the pooled experience across Truven Health customers. Truven Health Medical Episode Grouper provides clinically relevant treatment and cost groupings with a disease-based methodology that is risk-adjusted to fairly compare physicians and improve care management. Truven Health Physician Performance Assessment delivers information for improving the cost-efficiency and clinical effectiveness of physicians in easy-to-read report formats. It draws on the capabilities and power of Advantage Suite and the clinically robust Medical Episode Grouper. Truven Health Marketing Analytics offers insights for identifying specific individuals to target for individual health plans and the ability to maximize membership and analyze and optimize ROI. Truven Health Payment Integrity Enterprise suite of fraud algorithms, predictive models, audits, and investigations help our clients prevent, identify, and recover hundreds of millions of dollars. And our servicecentered model allows immediate deployment with actionable results and quantifiable ROI. The Truven Health Difference As the market leader in analytic methodologies, industry professionals rely on Truven Health products and services to improve the quality and efficiency of care. With leading data assets and extensive experience with health plans, employers, and government entities, Truven Health is uniquely qualified to help you address your business challenges. Our partnership with Truven Health helped us to be fast to market with an innovative, costeffective solution that meets the needs of our two key stakeholders individuals and healthcare professionals with minimal disruption to our business. Jim Nastri Vice President of New Product Development, CIGNA HealthCare 6

8 For more information Send us an at or visit truvenhealth.com ABOUT TRUVEN HEALTH ANALYTICS Truven Health Analytics delivers unbiased information, analytic tools, benchmarks, and services to the healthcare industry. Hospitals, government agencies, employers, health plans, clinicians, pharmaceutical, and medical device companies have relied on us for more than 30 years. We combine our deep clinical, financial, and healthcare management expertise with innovative technology platforms and information assets to make healthcare better by collaborating with our customers to uncover and realize opportunities for improving quality, efficiency, and outcomes. With more than 2,000 employees globally, we have major offices in Ann Arbor, Mich.; Chicago; and Denver. Advantage Suite, Micromedex, ActionOI, MarketScan, and 100 Top Hospitals are registered trademarks or trademarks of Truven Health Analytics. truvenhealth.com Truven Health Analytics Inc. All rights reserved. All other product names used herein are trademarks of their respective owners. HP