athenahealth, Inc. (NASDAQ: ATHN), a leading provider of internet-based business services to physician practices, and Physicians Practice®, America's leading practice management journal for physicians, today released the fifth annual PayerViewSM Rankings, which indicate that health insurers are paying physicians on average seven days faster and denying 12-18% fewer claims than revealed in last year.
“The administration passed legislation that simultaneously aims to expand access to care and rein in costs of health care delivery. It probably stands to reason that addressing the gaps in billing and administration has just become a more urgent mission”
For the second consecutive year, Humana Inc. ranked first in overall performance in the Major Payer segment, which includes Aetna, Champus/Tricare, Cigna, HCSC, Medicare B, UnitedHealth Group, and Wellpoint. Humana also ranked first in the National Commercial Payer segment, which includes Aetna, Cigna, and UnitedHealthcare. Payers' progress across several key metrics supports athenahealth's ongoing efforts on behalf of its national physician network to use PayerView as a lens to look into process gaps that exist in the complex relationship between payers and medical providers. Likewise, the data support continuing government and private sector efforts to drive costs down throughout the healthcare supply chain while expanding access to care for millions of patients through improved automation, transparency, and the exchange of healthcare information.
The complete 2010 PayerView Rankings and trends, evaluating 137 national, regional, and government payers in 43 states, can be found at www.athenahealth.com/PayerView
Based on the largest data set to date, the 2010 PayerView index tracks performance data from over 23,000 providers representing more than 39 million charge lines and $7 billion dollars in services billed in 45 states for the full year 2009. The data is derived from athenahealth's web-based medical billing and practice management platform, athenaCollectorSM, and ranks health insurers in areas of financial performance, administrative performance, and transaction efficacy. This year's PayerView Rankings, and athenahealth's ongoing collaborations with national and regional payers and physician advocacy work, underline the pressures on the health care industry to address extremely complex administrative burdens and processes and reduce costs across the healthcare delivery supply chain. These efforts are becoming increasingly critical as the U.S. prepares to absorb some 30 million newly insured patients under reform legislation and expand highly stressed state Medicaid programs.
"The administration passed legislation that simultaneously aims to expand access to care and rein in costs of health care delivery. It probably stands to reason that addressing the gaps in billing and administration has just become a more urgent mission," said Jonathan Bush, Chairman and CEO of athenahealth. "We know from the PayerView data and through our position as a trusted business partner for thousands of physicians across the country that plenty of challenges and opportunities still exist to address breakdowns between the front office and the exam rooms. The good news is we are seeing continued innovation, primarily driven by the private insurers like Humana who are leading through implementation of practical, tactical programs like bringing medical information online and being more transparent. If the industry can sustain this push towards greater efficiency, we can sustain physician participation and deliver better patient experiences."
Further, the previously announced March 2010 Physician Sentiment IndexSM issued by athenahealth and Sermo sheds light on physicians' frustrations trying to balance quality patient interactions with complex reimbursement protocols. The findings revealed a clear need for solutions that introduce new levels of transparency, automation, and efficiency into medical billing and practice management so that doctors can focus on being the best caregivers that they can be.
"PayerView was conceived with two ideas in mind," says Bob Keaveney, Editorial Director of Physicians Practice, which reports on the annual PayerView Rankings for its 200,000 readers. "First, to give physicians the only data-driven basis for judging their payers' administrative performance along dimensions that matter to providers, such as speed and ease of payment collection. And, second, to shed a light on the inefficiencies of the payment process in hopes of spurring payers to improve, while simultaneously highlighting areas in which providers themselves can improve as well. Although there is still room for improvement, these latest results suggest that both objectives are being met."
"We are proud about our position as a top performer in the PayerView Rankings," said Bruce Perkins, Senior Vice President of Healthcare Delivery Systems and Clinical Processes for Humana. For us, this is further evidence that our work to streamline and standardize claims processing, improve payment performance, and, broadly speaking, to shift more of the onus of administration off the shoulders of physicians, is paying dividends. The transparency afforded by PayerView and the athenahealth network introduces accountability into the payer community. It has become a mechanism for positive change. Humana and athenahealth are like-minded in mission making it easier for doctors to be in business by leveraging automation and the Internet."
The PayerView Rankings are designed to look at payers' performance based on a number of criteria that when combined provide an overall ranking that quantifies the "ease of doing business with the payer." All data used for the rankings come from the actual claims performance data of athenahealth providers and reflect athenahealth's direct experience dealing with individual payers nationwide.
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