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Payerview 2016: Collaboration is key

athenahealth® is proud to present the 2016 edition of PayerView, our annual review of the performance of the largest payers in our network.

PayerView is more than just an industry report card. We offer this year’s insights with an accompanying infographic that identifies strategies to help providers and payers zero in on opportunities for collaboration in our changing health care world.  As the shift from Volume to Value accelerates and the implementation of health care reform continues, now is the time for payers, providers and stakeholders to work together to address new challenges. View the PayerView 2016 infographic.

What the data shows

This year's analysis reveals shifts among payers who have historically been top performers in PayerView. In addition, many more payers met the inclusion criteria for PayerView for the first time this year, 29% more than in 2015.




National Commercial Payers: Powerful Administrative Performance

The robust experience and processes of the biggest commercial payers may be what drives their strong performance on administrative metrics. These payers also continue to adapt by engaging in mergers, acquisitions and the vertical integration of technology capabilities. New platforms and technologies present opportunities for innovation, collaboration and communication among payers, providers and other stakeholders.



Medicare Part B Payers: Leaders in First-Pass Claim Resolution

Medicare Part B payers benefit from strong, standardized claims adjudication systems and clear payment rules, allowing intelligence to be built into athena’s network and resulting in the highest rate of claims successfully paid on the initial attempt. In the event a claim is denied, clear actionable remittance advice avoids costs associated with follow-up activities and lowers call volume for payers and providers. Looking ahead, Medicare has set an ambitious goal of linking 50 percent of payments to alternative payment models like Accountable Care Organizations by 2018 - so Medicare Part B payers’ robust infrastructure should continue to evolve to support providers. 



Medicaid: Some Success in the Face of Unique Challenges

Medicaid payers, which include both state Medicaid programs and Medicaid Managed Care Organizations (MCOs), face unique challenges: administering a complex eligibility determination process, providing benefits to a member population undergoing consistent “churn,” and of course scaling up programs and services in states that opt for expansion under the Affordable Care Act.  Despite such challenges, Medicaid payers as a group perform well on the Eligibility Accuracy and Provider Collection Burden metrics, but have room for improvement on most others.