Tha latest PayerView Rankings indicate health insurers, on average, are paying physicians seven days faster and denying 12 percent to 18 percent fewer claims than last year.
The PayerView Rankings, released Monday by Watertown, Mass.-based healthcare IT vendor athenahealth in conjunction with Physicians Practice, a national practice manahgement journal for physicians, are designed to examine payers' performance based on a number of criteria that together quantify the "ease of doing business with the payer," according to athenahealth executives.
For the second consecutive year, Humana ranked first in overall performance in the major payer segment, which includes Aetna, Champus/Tricare, Cigna, HCSC, Medicare B, the UnitedHealth Group and Wellpoint. Humana also ranked first in the national commercial payer segment, which includes Aetna, Cigna and UnitedHealthcare.
According to athenahealth, payers' progress across several key metrics supports the company's efforts on behalf of its national physician network to look at process gaps that exist in the complex relationship between payers and medical providers. Likewise, officials said, the rankings support continuing government and private sector efforts to drive down costs throughout the healthcare supply chain while expanding access to care for millions of patients through improved automation, transparency, and the exchange of healthcare information.
Based on the largest data set to date, the 2010 PayerView index tracks performance data from more than 23,000 providers representing more than 39 million charge lines and $7 billion in services billed in 45 states in 2009. 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.
According to athenahealth executives, this year's rankings underscore pressures on the healthcare industry to address complex administrative burdens and processes and reduce costs across the healthcare delivery supply chain – efforts are that are increasingly critical as the nation prepares to absorb some 30 million newly insured patients under reform legislation and expand highly stressed state Medicaid programs.
"The administration passed legislation that simultaneously aims to expand access to care and rein in costs of healthcare delivery; it probably stands to reason that addressing the gaps in billing and administration has just become a more urgent mission," said Jonathan Bush, the company's chairman and CEO. "We know from the PayerView data ... that plenty of challenges and opportunities still exist to address breakdowns between the front office and the exam rooms. The good news is we are seeing continued innovation, primarily driven by the private insurers like Humana who are leading through implementation of practical, tactical programs like bringing medical information online and being more transparent."
A recent Physician Sentiment Index, issued in March by athenahealth and Sermo, a Cambridge, Mass.-based online physician community, sheds light on physicians' frustrations trying to balance quality patient interactions with complex reimbursement protocols. According to athenahealth officials, the findings revealed a strong desire for greater transparency, automation and efficiency in medical billing and practice management so that doctors can focus on their role as caregivers.
"PayerView was conceived with two ideas in mind," said Bob Keaveney, editorial diirector of Physicians Practice. "First, to give physicians the only data-driven basis for judging their payers' administrative performance along dimensions that matter to providers, such as speed and ease of payment collection. Second, to shed a light on the inefficiencies of the payment process in hopes of spurring payers to improve, while simultaneously highlighting areas in which providers themselves can improve as well. Although there is still room for improvement, these latest results suggest that both objectives are being met."
"We are proud about our position as a top performer in the PayerView Rankings," said Bruce Perkins, senior vice president of healthcare delivery systems and clinical processes for Humana. "For us, this is further evidence that our work to streamline and standardize claims processing, improve payment performance and, broadly speaking, to shift more of the onus of administration off the shoulders of physicians is paying dividends. The transparency afforded by PayerView and the athenahealth network introduces accountability into the payer community. It has become a mechanism for positive change."
The complete 2010 PayerView Rankings and trends, evaluating 137 national, regional and government payers in 43 states, can be found at www.athenahealth.com/PayerView.