About Group Health

Group Health (GH) is a term that encompasses many areas: medical, behavioral health, prescription drug, vision and/or dental health. GH subscribers are typically employees and their dependents, but other types of subscriber groups include churches and religious organizations, trade organizations, chambers of commerce, and special interest groups.

Group Health plans are funded in one of two ways:

• Fully-Insured: the employer contracts with a group health insurance provider. Premiums are typically paid by the employer and the employee.
• Self-insured: the employer pays claims and contracts with a third-party administrator (TPA) to administer the plan.

EMPAQ^® Metrics

EMPAQ^® metrics are ratios (i.e. numerators over denominators) that can be used to calculate the effectiveness of health and productivity management programs. They establish a consistent method for measuring cost, utilization and other performance issues.

EMPAQ^® GH Metrics

Click here for a copy of the EMPAQ^® Data Dictionary, which contains detailed definitions of all of the metrics, data elements and plan design questions.

There are 15 EMPAQ^® GH metrics that fall into 5 categories (Cost and Productivity, Behavioral Health Plan, Pharmacy Plan, Medical Plan, and Dental Plan). While many metrics address the active employee population, some metrics include calculations on the retiree and dependent populations as well.

Cost and Productivity Metrics

Metric	Ratio	Explanation
Group Health Program Costs per Covered Active Employee	Group Health Program Costs per Covered Active Employee = Medical Program Costs Paid by Employer for Covered Employees (Including Behavioral Health) + Pharmacy Program Costs Paid by Employer for Covered Employees + Total Dental Health Program Costs for Covered Employees Average Number of Group Health Covered Employees	This metric calculates the per covered employee cost of GH coverage for a defined period of time.
Group Health Program Costs per Active Employee	Group Health Program Costs per Active Employee = Medical Program Costs Paid by Employer for Covered Employees (Including Behavioral Health) + Pharmacy Program Costs Paid by Employer for Covered Employees + Total Dental Health Program Costs for Covered Employees Average Active Headcount	This metric calculates the per employee cost (including employees not enrolled in the plan) of GH coverage for a defined period of time.
Group Health Employee Contributions per Covered Active Employee	Group Health Employee Contributions per Covered Active Employee = Group Health Employee Contributions Average Number of Group Health Covered Employees	This metric calculates the average employee contribution paid per active covered employee for a defined period of time.
Group Health Employee Contributions per Active Employee	Group Health Employee Contributions per Active Employee = Group Health Employee Contributions Average Active Headcount	This metric calculates the average employee contribution paid per employee (including those not enrolled in the plan) for a defined period of time.

Behavioral Health Plan Metrics

Metric	Ratio	Explanation
Group Health Behavioral Health Costs per Covered Active Employee	Group Health Behavioral Health Costs per Covered Active Employee = If Separate, Behavioral Health Program Costs for Covered Employees If Separate, Average Number of Behavioral Health Covered Employees	This metric calculates the per covered employee cost of Behavioral Health program coverage for a defined period of time.

Pharmacy Plan Metrics

Metric	Ratio	Explanation
Group Health Pharmacy Costs per Covered Active Employee	Group Health Pharmacy Costs per Covered Active Employee = Pharmacy Program Costs Paid by Employer for Covered Employees Average Number of Pharmacy Plan Covered Employees	This metric calculates the per covered employee cost of Pharmacy program coverage for a defined period of time.

Medical and Dental Plan Metrics

Metric	Ratio	Explanation
Group Health Medical Costs per Covered Active Employee	Group Health Medical Costs per Covered Active Employee = Medical Program Costs Paid by Employer for Covered Employees (including Behavioral Health) Average Number of Medical Plan Covered Employees	This metric calculates the per covered employee cost of the Medical program coverage for a defined period of time.
Dental Health Cost per Covered Subscriber	Dental Health Cost per Covered Subscriber = Total Dental Health Program Costs for Covered Employees Average Number of Covered Subscribers for Dental Health	This metric calculates the per covered employee contract cost of the dental health program coverage for a defined period of time.
Total Group Health Costs for Covered Employees) per Active Employee	Total Group Health Costs (for Covered Employees) per Active Employee = Medical Program Costs Paid by Employer for Covered Employees (Including Behavioral Health) + Pharmacy Program Costs Paid by Employer for Covered Employees + Total Dental Health Program Costs for Covered Employees + Group Health Employee Contributions Average Active Headcount	This metric calculates the combined costs of the group health and dental health programs per active employee (including those not enrolled in the plans) for a defined period of time.
Group Health Contributions as a Percent of the Total Group Health Costs of Covered Active Employees	Group Health Contributions as a Percent of the Total Group Health Costs of Covered Actives Employees = Group Health Employee Contributions + Dental Health Employee Contributions Medical Program Costs Paid by Employer for Covered Employees (Including Behavioral Health) + Pharmacy Program Costs Paid by Employer for Covered Employees + Total Dental Health Program Costs for Covered Employees + Group Health Employee Contributions	This metric calculates the employee contributions (for both medical and dental plans) as a percentage of the program costs for the dental and group health programs.
Total Group Health Costs (for Covered Lives) per Active Employee	Total Group Health Costs (for Covered Lives) per Active Employee = Medical Program Costs Paid by Employer for Covered Lives (Including Behavioral Health) + Pharmacy Program Costs Paid by Employer for Covered Lives + Total Dental Health Program Costs for Covered Lives + Group Health Employee Contributions Average Active Headcount	This metric calculates the total program costs (medical, pharmacy, behavioral health, and dental) for active employees, spouses, retirees and dependents, per active employee (including those not enrolled in the plan), for a defined period of time.
Average Covered Lives for Group Health per Active Employee	Average Covered Lives for Group Health per Active Employee = Average Number of Covered Lives for Group Health Average Active Headcount	This metric calculates a ratio of the number of covered (enrolled) employees, including actives, spouses, retirees, and dependents, to the number of active employees (including those not enrolled in a plan.)
Total Group Health Cost per Covered Subscriber	Total Group Health Costs per Covered Subscriber = Medical Program Costs Paid by Employer for Covered Lives (Including Behavioral Health) + Pharmacy Program Costs Paid by Employer for Covered Lives + Total Dental Health Program Costs for Covered Lives + Total Group Health Subscribers' Contributions Average Number of Covered Subscribers for Group Health	This metric calculates the total program costs (medical, pharmacy, behavioral health, and dental) for active employees, spouses, retirees and dependents, per group health insurance contract, for a defined period of time.
Group Health Subscriber Contributions per Covered Subscriber	Group Health Subscriber Contributions per Covered Subscriber = Total Group Health Subscribers' Contributions Average Number of Covered Subscribers for Group Health	This metric calculates the total program costs (medical, pharmacy, behavioral health, and dental) for active employees, spouses, retirees and dependents, per group health insurance contract, for a defined period of time.
Group Health Subscriber Contributions as a Percent of the Total Group Health Costs of Covered Lives	Group Health Subscriber Contributions as a Percent of the Total Group Health Costs of Covered Lives = Total Group Health Subscribers' Contributions + Dental Health Employee Contributions Medical Program Costs Paid by Employer for Covered Lives (Including Behavioral Health) + Pharmacy Program Costs Paid by Employer for Covered Lives + Total Dental Health Program Costs for Covered Lives + Total Group Health Subscribers' Contributions	This metric calculates the cost of group health contributions from active employees, retirees, and dependents (the yearly contributions from group health premiums) as a percentage of the total program costs (medical, pharmacy, behavioral health, and dental for active employees, spouses, retirees and dependents.).