New report cards rate health insurers

Athenahealth, ReviveHealth report cards rate the insurers
By Bernie Monegain
10:29 AM
Grades on chalkboard

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."

"As the healthcare system transitions to more complex, value-based payment models, building on payers’ operational success and improving transparency is essential to gaining provider trust and making collaboration possible," said ReviveHealth CEO Brandon Edwards in a statement. "At a time when payers and providers are seeking new, untested partnerships and arrangements that require them to communicate with one another, trust is not always there. It is our desire that payers take note of these findings and use them to strengthen communications and collaboration with their healthcare provider and health system partners."

[See also: PayerView rankings show performance stuck in place.]

athenahealth PayerView key findings:

  • Humana ranks first in overall performance among major payers, followed by Aetna and Cigna. Small commercial payers continued to improve performance, while Blue Cross Blue Shield plans dominated the top 10 ranked payers. Integrated delivery systems’ health plans also proved to perform as well as some top commercial payers.
  • Market turbulence, including the ACA, did not degrade payer performance as expected. In 2013 and 2014 Medicaid Expansion states performed better than non-expansion states. Blue Cross Blue Shield plans and commercial payers offering health plans in the health exchanges (HIX) performed better than non-HIX carriers in both years. Payers participating in ACA implementation appear to be performing better overall.
  • Provider uncertainty surrounding ICD-10 is high with payer “readiness” still undefined by the industry. The majority of PayerView payers (87 percent) say they are testing for ICD-10, but the quality of testing varies, with a general belief that more transparency is needed. ICD-10 is a make-or-break opportunity for payers to build trust and prove performance under pressure.

ReviveHealth National Payor Survey key findings:

  • Provider trust in payers is once again relatively low, with most payers evidencing small declines in their Trust Index scores. Utilizing a 100-point scale, Cigna continued to lead as the most trusted payer with a composite Trust Index score of 62.7, a drop from 63.1 last year. UnitedHealthcare continued to rank the least trustworthy with a score of 40.5 compared to 40.7 last year. The average composite Trust Index score across all payers was 51.8, down slightly down (0.7 percent) from the year before.
  • Providers feel taken advantage of and are skeptical about payers’ ability to honor commitments. Across the board, major payers are seen as poor at balancing their interests against those of the providers. Best among the major players evaluated in the survey was Cigna (58.9); worst was UnitedHealthcare (34.7). This is further evidence of a festering disconnect between payers and providers.
  • Good faith negotiations are second in importance only to payment rates. Not surprisingly, payment rates for services provided was the factor rated most important by hospital leadership (29.3 percent), followed by negotiating in good faith (20.6 percent), showing how factors other than pure operational performance influence the feelings of providers toward payers.
  • Provider participation in financial risk-sharing is still low, but on the upswing. The group of 200-plus hospital leaders participating in this year’s survey said that collectively, they expect to get 82 percent of their total revenue in 2015 based on volume and only 18 percent based on value. Still, many are already participating in risk-sharing programs, with almost two-thirds in government-sponsored pay-for-quality programs and a similar number in accountable care organizations.