Source: Employer Measures of Productivity, Absence and Quality website (www.EMPAQ.org) Sep 4, 2010

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.

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 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, new metrics include calculations on the retiree and dependent populations as well.

Cost and Productivity Metrics
Metric Ratio Explanation
Program Cost per Covered Active Employee
Program Cost per Covered Active Employee = Group Health Program Costs for Covered Employees (net)
Average Number of Group Health Covered Employees
This metric calculates the per covered employee cost of GH coverage for a defined period of time.
Program Cost per Employee
Program Cost per Employee = Group Health Program Costs for Covered Employees (net)
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.
Employee Contribution per Covered Active Employee
Employee Contribution 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.
Employee Contribution per Employee
Employee Contribution per 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
Behavioral Health Costs per Covered Employee
Behavioral Health Costs per Covered Employee = Behavioral Health Program Costs For Covered 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 Costs per Covered Employee
Pharmacy Costs per Covered 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
Medical Costs per Covered Employee
Medical Costs per Covered Employee = Medical Program Costs Paid by Employer for Covered Employees
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 Employee
Dental Health Cost per Covered Employee = Dental Health Program Costs for Covered Employees
Average Employee Contracts Covered for Dental Health
This metric calculates the per covered employee contract cost of the dental health program coverage for a defined period of time.
Group Health Gross Cost per Active Employee (including Employee Contributions and Dental Program Costs)
Group Health Gross Cost per Active Employee (including Employee Contributions and Dental Program Costs) = Group Health Program Costs for Covered Employees (Gross) + Dental Health Program Costs for Covered Employees
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 % Group Health Costs of Actives
Group Health Contributions as % Group Health Costs of Actives = Group Health Employee Contributions + Dental Health Employee Contributions
Dental Health Program Costs for Covered Employees + Group Health Program Costs for Covered Employees (Gross)
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 Cost per Active Employee
Total Group Health Cost per Active Employee = Total Group Health
Program Costs
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 Total Covered Lives
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 Employee Contract
Total Group Health Cost per Covered Employee Contract = Total Group Health
Program Costs
Average Total Covered Contracts
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 Employee Contributions per Covered Employee Contract
Group Health Employee Contributions per Covered Employee Contract = Group Health Contracts' Contribution
Average Total Covered Contracts
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.
Total Group Health Contribution as % Group Health Costs of Covered Employee Contract
Total Group Health Contribution as % Group Health Costs of Covered Employee Contract = Group Health Contracts' Contributions
Total Group Health Program Costs
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.).


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