Humana snagged the top ranking among national payers – edging out last year's top payer, Aetna – in the fourth annual PayerView rankings published by athenahealth and the journal Physicians Practice.
"Humana's ascent to the top of the rankings can be credited to faster claims payment with fewer denials than its peers," said William F. Jessee, MD, president and CEO of the Medical Group Management Association. The MGMA serves 22,500 members who lead and manage more than 13,700 organizations in which almost 275,000 physicians practice.
"Receipt of fast, accurate payments is critical to effectively managing the business operations of physician practices." Jessee said. "While MGMA commends Humana for this important achievement there remains considerable room for improvement across the industry. Humana has shown a willingness to reach out directly to MGMA and carefully listen to the needs of our members. Its ability to embrace new technologies and adapt to meet the needs of its group practice customers is clearly beginning to pay off."
"We are honored to be named as top payer by athenahealth again this year," said Bruce Perkins, senior vice president of healthcare delivery systems and clinical processes for Humana. "This is a reflection of the work we are doing to eliminate the hassle factor or healthcare providers."
The report indicates national health insurers are paying physicians at a 5.3 percent faster rate and denying 9.0 percent fewer medical claims over the prior year.
The results support athenahealth's efforts to use PayerView as a framework to address gaps in the complex relationship between payers and medical providers on behalf of its national physician network, athenahealth executives said. The data also supports government and industry efforts to reduce administrative costs in healthcare and expand access to care through greater automation and transparency of health information, they said.
The 2009 PayerView report evaluated 172 national, regional and government payers in 40 states.
The top rankings are as follows:
- Humana
- Aetna
- Cigna
- United Health Group
- Medicare - B
- Wellpoint
- Champus/Tricare
- Coventry Health Care
This year's rankings represented the largest data set to date, according to athenahealth. The Watertown, Mass.-based company used performance data from more than 18,000 medical providers representing more than 41 million medical charge lines and $7 billion dollars in charges billed to payers in 47 states for all of 2008.
The data is derived from athenahealth's national electronic health record (EHR) and practice management platform, athenaNet. It ranks health insurers according to specific measures of financial performance, administrative performance and medical policy complexity.
The 2009 PayerView Rankings and athenahealth's work with national and regional payers highlight programs underway to automate claims and billing work conducted by physician practices in an effort to address growing healthcare administrative costs and streamline claims processing to allow providers and their staff to focus more on the delivery of care.
"With much of the current attention and dialogue on healthcare reform focusing on driving greater use of electronic health records, our latest PayerView data and ongoing collaborative efforts with payers illustrate the tremendous challenges and opportunities that exist in addressing the billing and administrative breakdowns in our care delivery system which represent the largest source of cost waste and burden for doctors and their patients," said Jonathan Bush, chairman and CEO of athenahealth.
The PayerView Rankings are designed to look at payers' performance based on a number of categories, which combine to provide an overall ranking aimed at quantifying the "ease of doing business with the payer," Bush said. All data used for the rankings come from actual claims performance data of athenahealth providers and depict athenahealth's experience in dealing with individual payers across the nation. The rankings include national payers with at least 120,000 charge lines of data and regional payers with a minimum of 20,000 charge lines.