Truven Rolls Out ACA-Compliant Benefit Modeling Tool

ANN ARBOR — Truven Health Analytics has released a new version of its Benefit Modeler tool that estimates the impact of benefit design changes, including new regulatory items required by the Affordable Care Act.

The Truven Health Benefit Modeler is an online analysis tool that supports employers, health plans, and benefits consultants in the evaluation of a broad range of plan types including high-deductible health plans. The new version contains updated actuarial assumptions based on the Truven Health MarketScan Commercial Claims database, as well as significant methodology and functionality changes to support healthcare reform, pharmacy benefit planning, and federal Minimum Value Calculator reporting.

Benefit Modeler now alerts users if design scenarios are not compliant with ACA requirements for ER and preventive services and out-of-pocket maximums. The tool also provides greater granularity for pharmacy reporting, including an added Specialty Drug tier and additional inputs for modeling major medical and pharmacy plan designs.

“Healthcare costs continue to rise, and payers are increasingly turning to data and analytics to evaluate what’s working and what isn’t,” said Barb Graovac, senior vice president at Truven Health Analytics. “By understanding the needs of a specific population and tailoring medical and prescription drug benefits to match those needs, payers can deliver high-quality outcomes and reduce costs, all while ensuring compliance.”

The upgrades to Benefit Modeler were developed in partnership with Wakely Consulting Group, a Clearwater, Fla.-based actuarial consulting firm in healthcare and healthcare reform.

The latest version supports HHS’ Minimum Value Calculator reporting, making Benefit Modeler a “one-stop” resource for plan design validation by including the values needed to produce a pass/fail report for each plan option.

“Healthcare benefits are becoming more complex due in part to the ACA and public and private exchanges”, said Julie Peper, director and senior consulting actuary at Wakely Consulting. “We’re committed to partnering with Truven Health to provide the detail needed for actuarial validation of new plan designs, as well as updated methodologies that keep up with changing market trends.”

Benefit Modeler is built on a large pool of MarketScan claims data, which includes information from more than 350 employers and 100 health plans and pharmacy benefit managers representing 36 million lives and all 50 states. To learn more about the Truven Health Benefit Modeler, visit

Truven is 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.

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