Data Shows Medicaid Continues to Underperform, While Blue Cross Blue Shield Plans Pull Ahead
WATERTOWN, Mass., May 28, 2014 (GLOBE NEWSWIRE) -- athenahealth, Inc. (Nasdaq:ATHN), a leading provider of cloud-based services for electronic health record (EHR), practice management, and care coordination, today announced the 2014 PayerView® Report, an annual report that leverages athenahealth's cloud-based data across its national network of health care providers to deliver unprecedented insight into the provider-payer relationship. For the second year in a row, Humana ranked 1st in overall performance amongst 148 payers.
An infographic accompanying this release is available at https://media.globenewswire.com/cache/8231/file/26659.pdf
The 2014 PayerView results rank commercial and government health insurers according to specific measures of financial, administrative, and transactional performance. These measures provide an objective, comparative benchmark for assessing how easy or difficult it is for providers to work with payers. Rankings are derived from athenahealth's athenaNet® database, which to date includes more than 52,000 providers across 50 states. The 2014 PayerView data set analyzes 108 million charge lines and $20 billion in health care services billed in 2013. Insights from the 2014 report reveal trends that providers should be aware of for possible impact:
#1: Medicaid's Lackluster Performance Continues
For the 9th straight year, Medicaid performed worse than commercial plans and Medicare on key metrics such as Days in Accounts Receivable (DAR), Denial Rates, and Electronic Remittance Advice (ERA) transparency. While some state Medicaids, such as Medicaid Connecticut, performed especially well on select metrics, like enrollment, as a whole the category continues to underperform. Even though it is too early to determine the impact of the Medicaid expansion on payer performance, with an expected 85 million enrollees by 20211, all providers who serve Medicaid populations should be aware of their state's expansion status and performance metrics. Understanding strengths and weaknesses related to Medicaid enrollment efficiency and denial rate can help providers prepare for increased Medicaid patient volume and potential associated administrative burden, as well as mitigate risk to their business.
#2: Providers' Burden to Collect on Claims Varies Widely
PayerView data indicates that provider collection burden (PCB), measured as the percent of charges transferred from the primary insurer to the next responsible party after the time of service, is increasing slightly. Historically, findings reveal that providers in the West are experiencing higher collection burden than those in other parts of the country. PayerView results reveal that Medicare and many Blue Cross Blue Shield plans require providers to collect large percentages of payments from patients, while Medicaids require minimal collection. Providers who shift their payer mix to include Medicare and Blue Cross Blue Shield plans may see their collection burden increase. Those providers may also be increasingly asked to explain the meaning of things like co-insurance, deductibles, and co-pays to patients.
#3: Blue Cross Blue Shield Plans Pay Providers the Fastest
As a category, Blue Cross Blue Shield plans reimburse providers most quickly, with an average of three fewer Days in Accounts Receivable compared to all other payers. On this measure, Blue Cross Blue Shield plans represent 20 of the top 25 performers, displacing major commercial payers' historical position as the leading category. As major participants on the health insurance exchanges, Blue Cross Blue Shield plans' performance signals a positive indicator that providers who serve patients covered by these plans can cater to increased patient volume without cash flow disruption.
#4: Commercial Payers Offer the Most Efficient Enrollments
While Medicaid enrollment proves particularly burdensome, national commercial payers' enrollment proves simplest. According to PayerView data, no commercial payers require enrollment for electronic data interchange or for enrollment documents to be sent via mail. As providers contemplate potential changes to the mix of payers with which they work, enrollment requirements and associated efficiencies should be considered. PayerView findings show that the industry has not adopted transaction-based enrollment, despite the existence of the ANSI X12 274 transaction. This would most likely be the most efficient method for payers and providers.
"This year's PayerView provides clear insight into how payers are succeeding and faltering across the United States. This information, now more than ever, is important to providers as many are shifting their payer mix to accommodate the influx of newly insured patients. The data reveals existing pain points for providers right now and, even more critically, areas of payer weakness that could have significant impact during the first full year of the Affordable Care Act," said Todd Rothenhaus, chief medical officer, athenahealth. "As the only HIT company with the national knowledge and data insight into the working relationship between health care providers and payers, PayerView is part of athenahealth's commitment to keep the industry abreast of trends and prepare providers to thrive through change, no matter what the industry at large is experiencing."
Aamer Hayat, CEO of Avecinia Wellness Center, said: "PayerView is integral to our marketing and growth strategy. We use the results to benchmark the performance of the insurance companies we work with most. Furthermore, when we negotiate contracts, it helps to have athenahealth's nationally-recognized database of payer information in our corner. PayerView also helps us identify potential patients to target in our marketing efforts, based on the policies they may carry. When we feel confident in the relationships we build with insurance companies, that informs the lasting relationships we're able to make with patients, too."
Dr. Peter Masucci, a pediatrician in Everett, MA agrees: "PayerView's payer rankings help me choose an ideal payer mix and make sound business decisions for my practice. We leverage this information for contract negotiations and when we review the health of our revenue cycle. athenahealth's ability to track and trend payers' metrics is a powerful tool. It is a win-win for both payers and providers and absolutely unique to athenahealth."
For more information on athenahealth's cloud-based services, which make PayerView possible, please visit www.athenahealth.com. To see the full 2014 PayerView Report, please visit www.athenahealth.com/PayerView.
Now in its ninth year, the annual PayerView report leverages insight from athenahealth's cloud-based network of more than 52,000 providers. By looking at data from athenaNet from the year prior, athenahealth is able to provide the industry with a comparative tool that characterizes the ease or difficulty of doing business with each payer. In order to effectively rank payers, a variety of metrics are evaluated that are essential to providers' success, including Days in Accounts Receivable (DAR), First Pass Resolve Rate (FPR), and Provider Collection Burden (PCB). Large national and regional payers also use PayerView to inform their own initiatives to improve the provider experience. Today, athenahealth employs a team of experts that work in parallel with major payers not only to monitor trends but to drive continuous change that benefits providers.
About athenahealth, Inc.
athenahealth is a leading provider of cloud-based services for electronic health record (EHR), practice management, and care coordination. athenahealth's mission is to be caregivers' most trusted service, helping them do well doing the right thing. For more information, please visit www.athenahealth.com.
1 CMS Report National Health Expenditure Projections (2011-2021)
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