The state of payer operations and provider perceptions: 6 findings

New findings on the state of payer performance and provider perceptions of those payers show that Humana ranks first in overall performance, while Cigna is the most trusted.

The findings are from athenahealth's PayerView Report and ReviveHealth's National Payor Survey and Trust Index.

The PayerView Report ranks the performance of 166 payers, based on metrics such as days in accounts receivable, first-pass claim resolution rate, denial rate and provider collection burden. Rankings are derived from athenahealth's athenaNet database, which includes more than 64,000 providers across 50 states. The 2015 PayerView data set analyzes 145 million charge lines and $28.5 billion in healthcare services billed in 2014.

ReviveHealth's ninth annual survey of national payers by hospital leadership was conducted Feb. 9 through March 20, in partnership with Catalyst Healthcare Research. The companies obtained responses from more than 200 hospital and health system leaders for the survey.

Here are three key findings from the ReviveHealth National Payor Survey.

1. Providers have low trust in payers overall. Cigna leads as the most trusted payer, while providers ranked UnitedHealthcare as least trustworthy.

2. Payment rates for services provided are rated most important by hospital leadership (29.3 percent) followed by negotiating in good faith (20.6 percent).

3. Provider participation in financial risk-sharing is still low, but going up. Hospital leaders surveyed expect to receive 82 percent of their total revenue in 2015 based on volume, and only 18 percent based on value.

Here are three key findings from the PayerView Report. 

1. Aetna and Cigna trail behind Humana as first overall among major payers.

2. Market turbulence, including the Patient Protection and Affordable Care Act, did not degrade payer performance as expected. Those offering health plans in Medicaid expansion states and on the health insurance exchanges are performing better than those that aren’t participating.

3. Barring an industry definition of "readiness," payers appear to be only partially operationally prepared for ICD-10.


More articles on payer issues:

Anthem poised for 'transformative' acquisition, CFO says

Will Aetna acquire Cigna, Humana? 3 things to know

Up to 17M women could lose mammogram coverage

Copyright © 2024 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.


Top 40 articles from the past 6 months