Humana ranks no. 1 in being easy to work with
For the second year in a row, Humana ranked first in overall performance among 148 payers, according to the 2014 PayerView Report, an annual report from athenahealth in Watertown, MA.
Athenahealth is a provider of cloud-based services for electronic health record (EHR), practice management, and care coordination.
The 2014 PayerView results rank commercial and government health insurers according to specific measures of financial, administrative, and transactional performance. These measures 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 athenaNet database, which includes more than 52,000 providers. The 2014 PayerView data set analyzes 108 million charge lines and $20 billion in health care services billed in 2013.
The 2014 report reveals these trends:
• Medicaid’s lackluster performance continues.
For the ninth straight year, Medicaid performed worse than commercial plans and Medicare on key metrics such as days in accounts receivable (DAR), denial rates, and electronic remittance advice (ERA) transparency. While some Medicaids, 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, with an expected 85 million 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.
• Providers’ burden to collect on claims varies widely.
Provider collection burden (PCB), measured as the percent of charges transferred from the primary insurer to the next responsible party after the time of service, is increasing slightly, data indicates. Historically, findings reveal that providers in the West are experiencing higher collection burden than those in other parts of the country. Medicare and many Blue Cross Blue Shield plans require providers to collect large percentages of payments from patients, while Medicaids require minimal collection.
Providers who shift their payer mix to include Medicare and Blue Cross Blue Shield plans might see their collection burden increase. Those providers also might be increasingly asked to explain the meaning of items such as co-insurance, deductibles, and co-pays to patients.
• 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, and they displace 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.
• 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.
To see the full 2014 PayerView Report, go to www.athenahealth.com/PayerView. An infographic accompanying this mews story is available at http://bit.ly/1rCXkFd.
