Payer Report Cards

athenhealth

PayerView^SM - an annual initiative run by athenahealth, Inc. - is the industry’s first quantitative report addressing the fundamental pain points that currently exist between insurers and providers. The idea behind PayerView^SM is to create an industry-wide dialogue on how breakdowns in these relationships can be addressed and improved.

Since 2006, athenahealth has ranked payers annually. Rankings reflect each payer's average score across seven specific metrics,* which roll into the following three categories, Financial Performance, Administrative Performance and Medical Policy Complexity.

For more information on the 2011 PayerView^SM rankings, click here.

*These metrics and rankings represent the collective experience of athenahealth’s physician client base, and correspond to a limited set of payers.

AMA

The AMA released its 2011 National Health Insurer Report Card earlier this year. This provides physicians and the general public a reliable and defensible source of critical metrics concerning the timeliness, transparency and accuracy of claims processing by health insurance companies. For more information or to obtain a copy of the report card, click here.

Verden Rankings

The Verden Ranking system evaluates how insurance companies (payers) behave from the perspective of physician practice management. The data used to rank the payers comes directly from the companies themselves, as gathered by the MPV Alert subscription service, which monitors insurer sites for any policy and procedure changes. Our purpose in analyzing this data is to take a look at which companies are relatively efficient at managing their networks and communicate well with their networks, and which ones simply move administrative burden to the providers’ plate. In addition to creating added accountability for the insurers, The Verden Rankings provide physicians and administrators with the opportunity to engage insurers on those issues thanks to access to that information.

The Verden Report summarizes the results into five key metrics important to any medical practice: Cost to Provider, Volume of Change, Clarity of Communication, Notification Period and Posting Integrity. Then, a score is calculated for each insurance company depending on its performance, policy change by policy change. For example, points are added as the volume of policy changes increases or as the changes negatively impact medical practices. Ultimately, the payers with the most points are the most expensive plans in which to do business.

For more information, and to view the latest rankings, please visit http://theverdengroup.com/rankings.html.