Aetna 'best performer' in athenahealth's annual ranking

By Healthcare IT News
11:22 AM

The sixth annual PayerView rankings place Aetna at top for performance across several survey segments. The PayerView Rankings are published each year by EHR company athenahealth and Physicians Practices, a practice management journal for physicians.

Results this year indicate that the majority of health insurers made incremental progress over last year in paying physicians, doing so on average, one day faster while denying 5 percent fewer claims.

[See also: athenahealth and Physicians Practice rank the payers.]

Aetna was the No. 1 payer in the Major Payer segment, which includes Humana, Champus/Tricare, Cigna, HCSC, Medicare B, UnitedHealth Group, and Wellpoint. Aetna also ranked first in the National Commercial Payer segment, which includes Humana, Cigna, and UnitedHealthcare.

The 2011 PayerView Rankings evaluate 132 national, regional, and government payers.

This year's index tracks performance data from more than 27,000 providers representing more than 47 million charge lines and $9 billion dollars in services billed in 41 states for the full year 2010. The data is derived from athenahealth's web-based medical billing and practice management platform, athenaCollector and ranks health insurers in areas of financial performance, administrative performance, and transaction efficacy. All data used for the rankings come from the actual claims performance data of athenahealth providers and reflect athenahealth's direct experience in dealing with individual payers nationwide.

Among the key findings and trends revealed:

  • National payers out-performed government payers; Aetna ranked top in first pass resolve rate (96.8 percent) and Humana had the lowest DAR (22.5 days) of the eight payers included in the Major Payer segment.
  • After achieving #1 in Eligibility Accuracy in the 2010 results, Medicare performance significantly declined in 2011. athenahealth data suggests that coordination of benefits information contained in Medicare's eligibility transaction does not correlate with Medicare's backend adjudication systems.
  • BlueCross BlueShield plans led payers in the transfer of responsibility to patients (according to PayerView, patient liability amounts are increasing across the industry).
  • ERA Transparency - a metric new to PayerView this year - reveals that while the industry at large has had a difficult time transitioning to the standard ERA code set, in some instances causing providers to rely on paper remittance, the State Medicaids have had the most difficult time adopting the standard (average ERA Transparency rate of 76.7 percent  compared to Medicare's rate of 97.1 percent).

Payers' progress across several key metrics validates athenahealth's ongoing efforts on behalf of its national physician network to use PayerView to uncover process gaps that exist between payers and medical providers. The rankings also highlight the pressures on the private and government sectors to improve complex administrative processes and reduce cost waste across the health care delivery supply chain. These efforts become even more urgent when set against the expansion of highly stressed state Medicaid programs (worst performers according to PayerView) under reform legislation.

[See also: Health plans, doctors’ groups find common ground.]

"PayerView has developed into something that allows physicians to regain leverage with payers because they now have as robust of a data set as the payers have," said Jonathan Bush, Chairman and CEO of athenahealth. "We're pleased to see that PayerView has become a motivational tool, used proactively by payers to identify and then mend their process breakdowns and improve their performance on a host of administrative issues that have long been sore points for practicing physicians."

"Payers used to only react to these rankings, as opposed to engaging and collaborating year-round in PayerView's mission of closing costly administrative breakdowns and getting doctors paid sooner for service rendered," says Bob Keaveney, editorial director of Physicians Practice, which reports on the annual PayerView Rankings for its 200,000 readers. "Six years in, this has morphed into an iterative process used to advantage by both sides - payers and physicians. It's an uncensored, completely transparent gauge of strides made and strides yet to be made. This year's data show that the government and private sectors in health care are capable of employing tactical, practical things like electronic transactions to drive efficiencies."