A mix of old and new school insurers are the best health plans in the eyes of the 59,000 physicians and providers using the digital billing and record-keeping services of athenahealth.
HealthPartners, Group Health Cooperative, several nonprofit Blues and one for-profit insurer, Humana, rank among the top 10 health plans in athenahealth's annual PayerView ranking among its physician clients.
The cloud-based EHR company's physicians rank their commercial and government insurers across nine financial, administrative and transactional metrics, including claims days in accounts receivable, denial rate and collection burden
"The mix of payers within this year's Top 10 Performers certainly reflects a changing payer landscape," wrote Kim Williams, athenahealth's executive director of payer intelligence. "Group Health Cooperative, HealthPartners, and Maryland MCO all succeed in small markets, and represent health plans where the traditional lines between payer and provider are blurred."
HealthPartners is a Minnesota-based not-for-profit HMO that also provides primary and speciality care, Group Health Cooperative plies a similar model in Washington State, and Maryland Physician Care MCO is a provider-sponsored Medicaid plan.
Maryland Physician Care MCO "was the biggest surprise," Williams said. "As these type of health plans become more prevalent, it will be interesting to see if more start landing at the top of the pack."
On the key financial metrics of importance to athenahealth's client physicians, HealthParters scored at the top. In 2014, it had 28.7 days in accounts receivable, a 96.6 percent first pass resolve rate and a 2.8 percent denial rate. Group Health Cooperative had 31 days in accounts receivable, a 95.8 percent first pass resolve rate and a 3.9 percent denial rate.
Humana, ranked at number three, had 27.9 days in accounts receivable, a 96.1 percent first pass resolve rate and a 5.6 percent denial rate.
At the bottom of the ranking, in a list of 166 health plans, were a number of Medicaid managed care plans. At the way bottom was Oklahoma Medicaid, which had 47.8 days in accounts receivable, a 84 percent first pass resolve rate and a 23 percent denial rate.
Others at the bottom were Centene's Superior Health Plan in Texas, UnitedHealthcare of the River Valley in Tennessee, Amerigroup New Jersey, Fallon Community Health Plan, and Horizon Blue Cross Blue Shield of New Jersey's Medicaid plan.