Athenahealth reveals best, worst payers

May 28, 2014 in Medical Technology

The annual PayerView Report, from health IT company athenahealth, released today, reveals the healthcare payer that has the best relationship with providers and the one that has the most problems.

The report found Blue Cross Blue Shield the fastest to pay providers.

To arrive at the rankings, athenahealth employed its cloud-based data across its national network of healthcare providers.

For the second year in a row, Humana ranked first in overall performance among 148 payers. And, for the ninth straight year, Medicaid performed the worst compared with all commercial plans and Medicare.

[See also: Humana ranked top payer in 2013.]

The 2014 PayerView results rank commercial and government health insurers according to specific measures of financial, administrative and transactional performance.

The goal, say athenahealth executives, is to provide an objective, comparative benchmark for assessing how easy or difficult it is for providers to work with payers.

Rankings are derived from athenahealth’s database, which to date includes more than 52,000 providers across 50 states. The 2014 PayerView data set analyzes 108 million charge lines and $20 billion in healthcare services billed in 2013.

[See also: athenahealth pinch-hits for government and athenahealth data shows kid obesity flat.]

The report’s key findings:

1. Medicaid’s lackluster performance continues
Medicaid performed worse than commercial plans and Medicare on key metrics such as days in accounts receivable, denial rates and electronic remittance advice transparency. While some state Medicaid plans, such as Medicaid Connecticut, performed especially well on select metrics, such as enrollment, as a whole the category continues to underperform.

“Even though it is too early to determine the impact of the Medicaid expansion on payer performance,” report authors write, “with an expected 25.6 percent increase in enrollees by 2021, all providers who serve Medicaid populations should be aware of their state’s expansion status and performance metrics. Understanding strengths and weaknesses related to Medicaid enrollment efficiency and denial rate can help providers prepare for increased Medicaid patient volume and potential associated administrative burden, as well as mitigate risk to their business.”

2. Providers’ burden to collect on claims varies widely
PayerView data indicates that provider collection burden, measured as the percent of charges transferred from the primary insurer to the next responsible party after the time of service, is increasing slightly. Historically, findings reveal that providers in the West are experiencing higher collection burden than those in other parts of the country. PayerView results reveal that Medicare and many Blue Cross Blue Shield plans require providers to collect large percentages of payments from patients, while Medicaid plans  require minimal collection. Providers who shift their payer mix to include Medicare and Blue Cross Blue Shield plans may see their collection burden increase. Those providers may also be increasingly asked to explain the meaning of things like co-insurance, deductibles and co-pays to patients.

3. Blue Cross Blue Shield plans pay providers the fastest
As a category, Blue Cross Blue Shield plans reimburse providers most quickly, with an average of three fewer Days in Accounts Receivable compared to all other payers. On this measure, Blue Cross Blue Shield plans represent 20 of the top 25 performers, displacing major commercial payers’ historical position as the leading category. As major participants on the health insurance exchanges, Blue Cross Blue Shield plans’ performance signals a positive indicator that providers who serve patients covered by these plans can cater to increased patient volume without cash flow disruption.

4. Commercial payers offer the most efficient enrollments
While Medicaid enrollment proves particularly burdensome, national commercial payers’ enrollment proves simplest. According to PayerView data, no commercial payers require enrollment for electronic data interchange or for enrollment documents to be sent via mail. As providers contemplate potential changes to the mix of payers with which they work, enrollment requirements and associated efficiencies should be considered. PayerView findings show that the industry has not adopted transaction-based enrollment, despite the existence of the ANSI X12 274 transaction. This would most likely be the most efficient method for payers and providers.

“This year’s PayerView provides clear insight into how payers are succeeding and faltering across the United States,” Todd Rothenhaus, chief medical officer, athenahealth,” said in a news release. “This information, now more than ever, is important to providers as many are shifting their payer mix to accommodate the influx of newly insured patients. The data reveals existing pain points for providers right now and, even more critically, areas of payer weakness that could have significant impact during the first full year of the Affordable Care Act.”

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