athenahealth and ReviveHealth Payer Report Cards Reveal Strong Performance but Weak Provider Trust of Payers Amidst Industry Transitions
Though the Affordable Care Act has not degraded payer performance, provider trust in payer behavior and relationships remains weak
WATERTOWN, Mass. and NASHVILLE, Tenn. May 20, 2015 – athenahealth, Inc. (Nasdaq: ATHN), a leading provider of cloud-based services and mobile applications for medical groups and health systems, and ReviveHealth, a leading integrated marketing communications firm, today released findings on the state of payer performance and provider perception of those payers.
athenahealth’s PayerView® Report™, which measures payers’ financial, administrative, and transactional performance, reveals that contrary to expectations, market turbulence resulting from the Affordable Care Act (ACA) has not caused operational challenges for most payers. In fact, those offering health plans in Medicaid expansion states and on the health insurance exchanges are performing better than those not participating.
PayerView’s top performing payers for efficiency, transparency, and consistency also received high marks in ReviveHealth’s ninth Annual Payor Survey and Trust IndexSM, which measures the behavioral reliability, honesty, and fairness of payers as perceived by hospitals and health systems. Cigna and Aetna ranked high in both reports, while UnitedHealthcare continued its year-over-year decline.
Yet despite the strong overall operational performance of payers, the Trust Index’s results reveal that provider trust of payers remains generally low, with nearly all of the major payers evidencing slight drops compared to last year. Further, results show perception gaps forming between some payers that are proven to have strong operations yet are inspiring low trust. These gaps imply an increased need for greater transparency and communication between the two industry segments.
“PayerView’s evidence-based insight, combined with the national provider survey data of ReviveHealth, reveals how payers are succeeding and faltering across the United States. Looking back on 2014, a year marked by the implementation of the ACA, we see that payer performance improved overall yet still might not be enough to fully support provider relationships and success amidst continued industry transformation,” said Todd Rothenhaus, Chief Medical Officer, athenahealth. “As providers increasingly take part in risk-sharing models and navigate big changes such as ICD-10, finding payer partners that have strong core operations and are differentiated on performance and transparency will be key. The financial, administrative, and transaction metrics that we use to rank payers provides a powerful guide for providers as they work to serve patients and get paid most efficiently.”
Brandon Edwards, ReviveHealth CEO, said: “As the healthcare system transitions to more complex, value-based payment models, building on payers’ operational success and improving transparency is essential to gaining provider trust and making collaboration possible. At a time when payers and providers are seeking new, untested partnerships and arrangements that require them to communicate with one another, trust is not always there. It is our desire that payers take note of these findings and use them to strengthen communications and collaboration with their healthcare provider and health system partners.”
Additional details from the national studies include:
athenahealth PayerView Key Findings:
- Humana ranks 1st in overall performance among major payers, followed by Aetna and Cigna. Small commercial payers continued to improve performance, while Blue Cross Blue Shield plans dominated the top 10 ranked payers. Integrated delivery systems’ health plans also proved to perform as well as some top commercial payers.
- Market turbulence, including the ACA, did not degrade payer performance as expected. In 2013 and 2014 Medicaid Expansion states performed better than non-expansion states. Blue Cross Blue Shield plans and commercial payers offering health plans in the health exchanges (HIX) performed better than non-HIX carriers in both years. Payers participating in ACA implementation appear to be performing better overall.
- Provider uncertainty surrounding ICD-10 is high with payer “readiness” still undefined by the industry. The majority of PayerView payers (87 percent) say they are testing for ICD-10, but the quality of testing varies, with a general belief that more transparency is needed. ICD-10 is a make-or-break opportunity for payers to build trust and prove performance under pressure
ReviveHealth National Payor Survey Key Findings:
- Provider trust in payers is once again relatively low, with most payers evidencing small declines in their Trust Index scores. Utilizing a 100-point scale, Cigna continued to lead as the most trusted payer with a composite Trust Index score of 62.7, a drop from 63.1 last year. UnitedHealthcare continued to rank the least trustworthy with a score of 40.5 compared to 40.7 last year. The average composite Trust Index score across all payers was 51.8, down slightly down (0.7 percent) from the year before.
- Providers feel taken advantage of and are skeptical about payers’ ability to honor commitments. Across the board, major payers are seen as poor at balancing their interests against those of the providers. Best among the major players evaluated in the survey was Cigna (58.9); worst was UnitedHealthcare (34.7). This is further evidence of a festering disconnect between payers and providers.
- Good faith negotiations are second in importance only to payment rates.Not surprisingly, payment rates for services provided was the factor rated most important by hospital leadership (29.3 percent), followed by negotiating in good faith (20.6 percent), showing how factors other than pure operational performance influence the feelings of providers toward payers.
- Provider participation in financial risk-sharing is still low, but on the upswing. The group of 200+ hospital leaders participating in this year’s survey said that collectively, they expect to get 82 percent of their total revenue in 2015 based on volume and only 18 percent based on value. Still, many are already participating in risk-sharing programs, with almost two-thirds in government-sponsored pay-for-quality programs and a similar number in accountable care organizations.
In its 10th consecutive year, athenahealth 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 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.
View or download athenahealth PayerView findings at www.athenahealth.com/Payerview.
About the Revive Health Annual Payor Survey and Trust Index
ReviveHealth’s ninth annual survey of national payers by hospital leadership revealed continued low scores on trust measures, with nearly all of the major plans evidencing slight drops. This underlines a continuing trend of disconnection and mistrust between hospitals and health plans. The survey, conducted February 9 – March 20, 2015, in partnership with Catalyst Healthcare Research, obtained responses from more than 200 hospital and health system leaders.
About athenahealth, Inc.
athenahealth is a leading provider of cloud-based services for electronic health records (EHR), revenue cycle management and medical billing, patient engagement, care coordination, and population health management, as well as Epocrates and other point-of-care mobile apps. We connect care and drive meaningful, measurable results for more than 64,000 healthcare providers in medical practices and health systems nationwide. For more information, please visit www.athenahealth.com.
About Catalyst Healthcare Research
Catalyst Healthcare Research is a national specialist in meeting the research needs of health providers, health plans, and suppliers to the healthcare industry. Drawing on a range of traditional and new research methods, we specialize in helping organizations understand, measure, and leverage the customer experience.
ReviveHealth is the leading integrated marketing communications firm specializing in Health Systems, Health Services, Health Technology, and Healthy Living. Named 2014 Small Agency of the Year (PRWeek), 2013 Boutique PR Agency of the Year (PRWeek), Best Boutique Agency to Work For (2011-2014), and Best Agency to Work For in America (2014) by The Holmes Report, we are among the nation’s Top 10 firms for healthcare marketing communication (O’Dwyer’s). Our clients include major health systems, academic medical centers, hospitals and physician organizations as well as healthcare industry associations, health technology companies, wellness and population health companies, and health services companies of all stripes and sizes, from start-up to enterprise solutions. We have offices in Nashville, Minneapolis, and Santa Barbara, and can be found on the web at thinkrevivehealth.com and on Twitter @ThinkRevive.