Providers Grade Health Plans. Guess Who Still Stinks.

Hospital and health system leaders continue to have a poor opinion of WellPoint and UnitedHealthcare.

An annual survey of hospital leaders' opinions of large health plans, released Wednesday, shows both organizations fighting for last place among their peers, Cigna, Aetna, Coventry, Humana, and independent Blue Cross Blue Shield (BCBS) plans. WellPoint ranked worst in overall favorability for the second consecutive year.

"It's, in some ways, statistically astonishing that a health plan that only directly contracts in 14 states can be perceived as having the worst reputation overall," says Brandon Edwards, CEO of Revive Health, which released the National Payor Survey.

WellPoint is the country's second largest insurer, and is coming off a rocky 2012 that included CEO Angela Braly's resignation and five consecutive quarters of earnings decreases, though it seems the company's financial forecast has turned around with its most recent earnings report showing higher-than-expected gains.

The survey questioned 373 hospital and health system leaders responsible for negotiating managed care contracts. They ranked independent BCBS plans as the most favorable health plan to deal with, which is ironic, since WellPoint is the BCBS licensee for more than a dozen states. It shows that a company can't take for granted a strong brand name. It has also to deliver on the brand promise.

Independent BCBS plans were also ranked best at dealing with hospitals, paying claims promptly, and partnering with hospitals on new initiatives. Hospital leaders, however, ranked the health plan as paying the lowest reimbursement rates, proving there's no correlation, in this case, between rates and overall satisfaction.

Edwards likens BCBS to Medicare, saying that providers don't like the rates, but "they know what they're getting." The positive ratings some BCBS plans enjoy could position the carrier to weather the uncertain environment in 2014 when health insurance exchanges will be in full effect.

Here's the overall favorability ranking according to the survey results:

1. BCBS

2. Cigna

3. Aetna

4. Coventry

5. UnitedHealthcare

6. Humana

7. Wellpoint/Anthem

Interestingly, the hospitals' opinions of the large health plans mirror those of physician practices. MGMA-ACMPE conducted a similar survey of its members in November 2012. They ranked UnitedHealthcare last in overall satisfaction. In fact, the bottom three in that survey are the same bottom three in Revive's polling.

Historically, the relationship between health plans and the hospitals and physician practices has not been great, to put it mildly. Is communication between them at an all-time low? Probably not, but it doesn't bode well on the near-eve of health insurance exchanges, value-based care incentives, and other payment models that require providers and payers to share more information to aid in better value, care, and quality for patients.

And the survey shows hospitals moving toward more collaborative models of care with payers. Last year, only 36% reported being in a phase of ACO implementation; this year that percentage jumped to 51%.

There was also an increase in the number of hospitals reporting that they have two or more payer contracts that included established quality criteria. In 2012, 37% of hospitals said those contracts existed; this year, it rose to 47%—nearly half.

Despite the increase in hospitals and payers participating in some type of collaborative agreement this year, the lowest contracting priorities are the industry's top buzzwords: bundled payments, ACOs, and population health strategies.

The survey was conducted between February and March using a combination of phone and online portal interviews. Revive says respondents were screened to "make sure they were responsible for negotiating contracts with major health plans."

Of those responding, 17% were identified as C-suite executives, 19% were VPs of managed care, 37% were the equivalent of a director, and 27% were responsible for either contracting or revenue cycle activities.