SYS-CON MEDIA Authors: Peter Silva, Liz McMillan, Yeshim Deniz, Elizabeth White, Pat Romanski

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Truven Health Analytics Launches Cost-Sharing Reduction Analysis and Reconciliation Solution for Health Insurance Exchanges

Truven Health Analytics, a leading provider of healthcare analytics and data solutions and services, today announced the launch of a new cost-sharing reduction analysis and reconciliation solution designed to reduce the administrative burden on qualified health plans. Developed as part of Truven Health’s suite of Affordable Care Act (ACA) Exchange Solutions, the new analytic offering helps health plans accurately forecast their cost-sharing obligations for enrollees who are eligible for income-based out-of-pocket cost reductions.

“Our quick-to-market solution addresses new regulatory requirements and offers early insights for health plans to effectively manage this potential liability,” said Mike Boswood, president and CEO of Truven Health Analytics.

Under the ACA, lower-income individuals who purchase health insurance through an exchange may be eligible to participate in cost-sharing reduction programs, which limit out-of-pocket spending for items such as office visits and prescription drug co-pays. Qualified health plans receive payment from the Centers for Medicare and Medicaid Services (CMS) in advance of service, based on estimates of their total cost-sharing exposure over the course of a year. At the end of each year, these payments must be reconciled with CMS, either via a “simplified” methodology based on actuarial estimates or via standard, audited reporting.

“With approximately 80 percent of individuals enrolled in silver-level plans currently eligible for cost-sharing assistance, budget forecasting and reconciliation processes present significant new challenges for health plans,” said Barb Graovac, Senior Vice President at Truven Health Analytics. “Our cost-sharing reduction services make it possible for health plans to quickly gauge their exposure and immediately make any necessary adjustments to ensure that they are aligned with program requirements.”

The Truven Health cost-sharing reduction analysis and reconciliation solution was developed to help health plans accurately forecast cost-sharing exposures, validate payments to eligible members, and reconcile year-end results. Truven Health is also working with Wakely Consulting Group, a leading actuarial services consulting firm servicing the healthcare industry, to provide actuarial certification for health plans requiring that service.

According to a Truven Health Analytics survey of ACA silver plan health insurance providers, 55 percent of respondents said they plan to conduct a simplified cost-savings reduction reconciliation this year, while 45 percent said they would use the standard method. By implementing Truven Health’s cost-sharing reduction services, health plans are able to easily execute both approaches with the utmost accuracy.

For more information on the Truven Health suite of ACA Exchange Solutions, please click here.

About Truven Health Analytics

At Truven Health Analytics we are dedicated to delivering the answers our clients need to improve healthcare quality and reduce costs. We are a healthcare analytics company with robust, widely-respected data assets and advanced analytic expertise that have served the global healthcare industry for more than 30 years. These combine with our unique perspective from across the entire healthcare industry to give hospitals, clinicians, employers, health plans, government agencies, life sciences researchers, and policymakers the confidence they need to make the right decisions, right now, every time. With our healthcare-specific expertise and tools for managing complex and disparate data, we understand how to implement and integrate tailored analytics that drive improvement.

Truven Health Analytics owns some of the most trusted brands in healthcare, such as Micromedex, ActionOI, 100 Top Hospitals, MarketScan, and Advantage Suite. Truven has its principal offices in Ann Arbor, Mich.; Chicago; and Denver. For more information, please visit http://truvenhealth.com.

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