New report cards rate health insurers
May 20, 2015 in Medical Technology
Payer report cards released today by health IT company athenathealth and healthcare marketing communications firm ReviveHealth show payers strong on operational performance, but lacking in provider trust.
Humana ranks No. 1 in overall performance among major payers, according to athenahealth’s PayerView Report, followed by Aetna and Cigna.
PayerView, which measures payers’ financial, administrative and transactional performance, reveals that, contrary to expectations, market turbulence resulting from the Affordable Care Act has not caused operational challenges for most payers. Moreover, those offering health plans in Medicaid expansion states and on the health insurance exchanges are performing better than those not participating.
PayerView’s top performing payers for efficiency, transparency, and consistency also received high marks in ReviveHealth’s Payor Survey and Trust Index, which measures the behavioral reliability, honesty, and fairness of payers as perceived by hospitals and health systems.
Cigna and Aetna ranked high in both reports, while UnitedHealthcare continued a year-over-year decline.
Despite the strong overall operational performance of payers, the Trust Index results reveal that provider trust of payers remains generally low, with nearly all of the major payers showing slight drops compared to last year.
Also, results show perception gaps forming between some payers that are proven to have strong operations yet are scoring low on trust. These gaps suggest an increased need for greater transparency and communication between the two industry segments, according to the reports. “Providers feel taken advantage of and are skeptical about payers’ ability to honor commitments,” ReviveHealth states in its findings.
“PayerView’s evidence-based insight, combined with the national provider survey data of ReviveHealth, reveals how payers are succeeding and faltering across the United States,” said Todd Rothenhaus, chief medical officer at athenahealth, in announcing the results of the annual report. “Looking back on 2014, a year marked by the implementation of the ACA, we see that payer performance improved overall yet still might not be enough to fully support provider relationships and success amidst continued industry transformation.”
[See also: Athenahealth reveals best, worst payers.]
“As providers increasingly take part in risk-sharing models and navigate big changes such as ICD-10, finding payer partners that have strong core operations and are differentiated on performance and transparency will be key,” Rothenhaus added. “The financial, administrative, and transaction metrics that we use to rank payers provides a powerful guide for providers as they work to serve patients and get paid most efficiently.”