PayerView rankings show performance stuck in place

By Bernie Monegain
10:17 AM
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Payer performance improvement remained flat in 2011, according to the seventh annual PayerView rankings released today by health IT company athenahealth. That's attributed in part to new compliance measures and major information technology shifts.

Though they did not perform as well as 2010, Humana and Aetna remained top performers, and UnitedHealthcare led the national payers.

It’s the first time since 2008 that payers have not boosted performance, said Patricia Andriolo-Bull, vice president of payer business development for athenahealth. “We do believe that there is a point of saturation so it becomes harder as time goes on to get better.”

Andriolo Bull said over the next three to five years, she expects the different aspects of health reform will affect both payers and consumers. With the increased purchase of high-deductible health plants, she said, patient co-pays are likely to increase, and there will be more pressure to collect upfront.

The PayerView project employs aggregate claims data made available through athenahealth’s cloud-based network of 33,000 providers to analyze insurance payer performance and to provide an objective, quantitative measure of providers' "ease of doing business" with individual payers.

The resulting data helps foster an industry-wide dialogue on how breakdowns in the medical claims billing process can be addressed. Complete rankings and correlating trends can be found at athenahealth.com/PayerView.

At a high level, PayerView revealed that in 2011 insurance payer performance remained flat, and in some cases reversed, with regards to getting physicians paid promptly and without excessive work.

While on the surface the data suggests comparative under-performance, a deeper dive suggests payers were challenged with major information technology shifts and new compliance obligations that affected not only the payers, but all of their trading partners as well.

Data on claims resolution and denials exposed the first signs of supply chain disruption from conversion to ANSI 5010, presaging difficulties that may lie ahead with the changeover to ICD-10. As a result, in the midst of grappling with these industry changes and meaningful use, physicians were forced to take on more of the work and hassle of collecting patient payments without any benefit of improved operational efficiency.

“While we speculate that market forces around the transition to ANSI 5010 are at least partially responsible for insurance payer performance, it’s less clear what role resources put against reform, or put on hold, may have played,” said Jonathan Bush, chairman and CEO of athenahealth. “We found that for major payers and Medicare, days in accounts receivable and first pass resolution rate both slipped slightly, signaling the beginning of the 5010 transition. The question might be asked: ‘With this degree of impact on performance prior to the 5010 transition ... what can providers expect with the transition to ICD-10?’”

Resources previously aimed at reimbursement performance appear to have been re-appropriated in 2011 as payers focused resources on addressing ANSI 5010, Bush said. As conversions to 5010 only just began in earnest in late 2011, the expectation is that performance in 2012 will stagnate or decline as well.

Other key findings:

  • Medicaid was the only group to show improvement in DAR rates (albeit less in 2011) but is still about 20 days higher than the weighted averages of the other groups.
  • The transference of collection from the payer to the next responsible party further squeezes the viability of independent practices. Also, with consumers footing more of the bill, the physician is forced into a reluctant role as collection agent, potentially compromising the physician-patient relationship. Provider collection burdens have continued to increase from 2010 to 2011 (a 7 percent  lift from 16.7 to 17.8 percentage points) among all payers.
  • The Blues slowed collection burden rates considerably between 2010 and 2011.
  • The rankings also revealed certain geographic disparities with regard to provider collection burden rates: At 17.7 percent, the Northeast had the lowest overall amount transferred to the next party. At 23.5 percent, the West ranked highest in terms of collection burden transfer.

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