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.
For EMPAQ® purposes, GH refers to the inclusion of only medical, behavioral health and prescription drug benefits. Dental and vision benefits are not included in the definitions of any EMPAQ® metrics.
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.
When you submit data to EMPAQ®, the secure online data submission tool will automatically calculate metrics for you. Simply enter your data (i.e. numerator and denominator values) into the tool and EMPAQ® will calculate the metrics for analysis and reporting. The results will be delivered to you as a set of benchmarking and decision-support reports.
EMPAQ® GH Metrics
There are 8 EMPAQ® GH metrics that fall into 4 categories (Cost and Productivity, Behavioral Health Plan, Pharmacy Plan, and Medical Plan).
Cost and Productivity Metrics
| Metric |
Ratio |
Explanation |
| Group Health Program Cost per Covered Employee |
| Group Health Program Cost per Covered Employee |
= |
Total Program Costs Minus
Employee Contributions
Average Number of Covered Employees |
|
This metric calculates the per covered employee cost of GH coverage for a defined period of time. |
| Group Health Program Cost per Employee |
| Group Health Program Cost per Employee |
= |
Total Program Costs Minus
Employee Contributions
Average 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 Contribution per Covered Active Employee |
| Group Health Employee Contribution per Covered Active Employee |
= |
Employee Contributions
Average Number of Covered Employees |
|
This metric calculates the average employee contribution paid per active covered employee for a defined period of time. |
| Group Health Employee Contribution per Employee |
| Group Health Employee Contribution per Employee |
= |
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 |
| Behavioral Health Program Cost per Covered Active Employee |
| Behavioral Health Program Cost per Covered Active Employee |
= |
Behavioral Health Program Costs For Active Employees
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 |
| Pharmacy Plan Program Cost per Covered Active Employee |
| Pharmacy Plan Program Cost per Covered Active Employee |
= |
Pharmacy Program Costs Paid by Employer
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 Plan Metrics
| Metric |
Ratio |
Explanation |
| Medical Plan Program Cost per Covered Active Employee |
| Medical Plan Program Cost per Covered Active Employee |
= |
Medical Program Costs Paid by Employer
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. |
| Medical and Behavioral Health Program Cost per Covered Active Employee |
| Medical and Behavioral Health Cost per Covered Active Employee |
= |
Behavioral Health Program Costs for Active Employees + Medical Program Costs Paid by Employer
Average Number of Medical Plan Covered Employees |
|
For those companies that separate out Behavioral Health program costs from Medical Costs, this metric provides the per covered employee total cost (Medical and Behavioral programs combined) for a defined period of time. |
|