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Are National Payers Edging Past Regionals?

by Melissa Lukowski, Director of Payer Outreach

New to this year’s 2010 PayerView results is the debut of a lens that ranks “All Payers” included in the athenahealth PayerView dataset. A total of 137 payers were included, with top performers representing payers from across a variety of groups.

The top 10 ranked payers are: 

1. BCBS-RI

2.  Humana

3. BCBS-MA

4. United Healthcare

5. Tufts

6. BCBS-OH

7. Medicare B-GA

8. Medicare B-NC

9. Medicare B-OR

10. ODS Health Plan

Despite the notion that health care is regional and regional payers should dominate, that may not be so.

athenahealth 2010 PayerView results indicate that national payers are competitive when rated against measures that matter to providers, such as speed of payment and transparency of billing guidelines.  

Based on our experience, it’s believed that standard transactions such as claims, eligibility, and electronic remittance advice have a role in leveling the playing field.  In reviewing the top performers, payers that are able to leverage standard transactions, and complement with a streamlined business process, will generally outperform peers that aren’t able to do so. 

While PayerView results suggest that the ease of working with a national payer is on par with regional payers, it is unclear if local presence and knowledge of the market can change a provider’s perception of that burden. 

Several things come to mind:

- Do you think that standard transactions are playing a role in leveling the playing field?  Have transaction standards given everyone the same playbook, and therefore reduced the need to tailor to local markets?

- Why is it so surprising to see national payers bubble to the top?  Shouldn’t national payers be able to leverage centralized functions while aligning with local market needs?

- Can we still say that health care is local?  What are the implications to those that currently participate in the supply chain?

Send back your comments and we can start a discussion.

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