PayerView 2014

2014 Overall Top 10 Performers

#1 Humana
#2 Healthpartners
#3 BCBS-MA
#4 Cigna-Healthsource
#5 Group Health Cooperative
#6 Medicare B-MO
#7 BCBS-PA Capital Blue Cross
#8 BCBS-DC
#9 Medicare B-IN
#10 Medicare B-OR

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2014 Highlights

  • While some state Medicaids are high performers, many remain the toughest to do business with, being among the slowest paying, least transparent payers.
  • Provider burden to collect on claims varies widely by payer and region and is likely to increase over the near term.

PayerView® provides practical insight into the healthcare reimbursement process to help practices respond to industry trends.

The 2014 PayerView Report reflects 2013 payer data that can help providers anticipate the impact of health reform:

  • Due to Affordable Care Act exchanges, Medicaid patients began to increase in 2013 and are projected to increase more dramatically in 2014 and beyond.
  • Medicaids continue to take the longest time to pay claims and also deny claims at the highest rate, putting a greater burden on providers.
  • Many health plans offered in the state and federal marketplaces have deductibles and co-pays higher than existing commercial, which could increase the provider collection burden in 2014.
  • Medicaid enrollment requirements are particularly burdensome; adding to providers' administrative burden when dealing with expanded Medicaid business.

This year’s PayerView is dedicated to helping providers use payer performance data to identify risks to their bottom line, and to maintain smooth operations in light of industry change.

As the impact of these trends becomes greater, it will be important for providers and payers to work closely together to solve the problems that arise. In order to do this, both need to understand what is happening in healthcare reimbursement. The purpose of PayerView is to identify where payers and providers could better focus their efforts.

PayerView is a natural product of the unique data that athenahealth continuously compiles on healthcare reimbursement and manages on behalf of its clients. Unlike other medical billing, EHR, and patient communication solutions, athenahealth uses a combination of centrally hosted, cloud-based software tools and robust back-office services. Because each of our more than 50,000 providers shares a single web-based instance of software, data and intelligence are pooled through a powerful network effect. This means that every detail of every billing transaction—patient eligibility check, claim submission, processing time at the payer, claim denials, receipt of electronic or paper remittance, and more—is captured electronically across our national network of providers.

We distill our information into quantitative rankings. Since its launch in 2006, PayerView has provided a unique framework that systematically addresses unnecessary administrative complexity in healthcare reimbursement. PayerView is designed to evaluate each payer's performance based on a number of key metrics which, when combined, provide an overall ranking that attempts to quantify the ease of doing business with that payer.

All data comes from the actual claims performance of payers that work with athenahealth providers, and reflects athenahealth's experience in dealing with individual payers across the U.S. While our claims billing data set isn't perfect—as no single set can be—through PayerView we strive to bring transparency and process integrity to the analysis of the provider-payer relationship.

This year’s PayerView provides clear insight into how payers are succeeding and faltering. The data reveals existing pain points for providers and, even more critically, areas of payer weakness that could have significant impact during the first full year of the Affordable Care Act. 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.

Todd Rothenhaus, M.D.,
Chief Medical Officer, athenahealth


Read our Metric Data and PayerView Disclaimer.


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