Athenahealth's annual survey of health plans puts a premium on metrics that gauge healthcare providers' experiences with their payer partners.
The 11th edition of the EHR, practice management, and population health services company's PayerView Report ranked 215 health plans on eight performance metrics. Last year's report ranked 166 payers on nine metrics, with Bloomington, MN-based HealthPartners earning the No. 1 honor.
Healthcare providers' experiences with their payer partners looms large in the PayerView Reports and is a primary focal point at Cigna, says Julie Vayer, vice president of total health and network operations at the commercial payer.
"Cigna has thousands of people who work hard every day to do right by our customers, clients, and healthcare providers. This is particularly important to us since the experience providers have with us affects both customers' perceptions of Cigna and our ability to be providers' partner of choice in emerging value-based care models."
The Top 10
Blue Cross Blue Shield health plans dominated the rest of the Top 10 of the 2016 PayerView Report:
According to the report: "Three factors appear to be largely responsible for [BCBS] success:
- Leveraging collaboration across the Blue Cross Blue Shield association and parent company;
- Encouraging a focus on quality improvement efforts, including sharing of best practices; and
- Centralizing guidance on key initiatives (e.g. ICD-10)
The Blues scored well on several performance metrics such as claims denial rate, posting a 6% average denial rate compared to a 9.2% average denial rate for all health plans that were surveyed.
Connecticut-based Cigna has about 37,000 employees in 30 countries, according to the company's 2014 Corporate Responsibility Report, which pegged total revenue at $34.9 billion in 2014. The company's large scale poses a challenge in terms of claims administration performance, Vayer says.
"Being a large national payer means we process a huge number of claims across multiple product lines and states. That makes our job enormously complex as we strive to process claims accurately and quickly."
Investing in technology, administrative capabilities and personnel have been critically important to rising to the scale challenge, she says.
"This includes specific investments to further improve claim accuracy, since we know how critical that is to providers. However, while technology is important, it's not the only factor that drives performance."
"We have also focused on embedding the right business logic into our systems so that administrative issues are minimized for customers and providers," says Vayer.
"And they can focus on getting and delivering the right care. And we've also invested in our people, because it takes well-trained people in addition to technology to get results we can all be happy with."
The assessment methodology of the 2016 PayerView Report is based on nine measures of claims-handling proficiency:
Cigna scored well on all three of the metrics with the highest weights, Vayer says.
"Our goal is for providers to view us as being easy to do business with. We see our performance on several key metrics that account for 50% of the PayerView score—days in accounts receivable, first-pass resolve, and denial rate—as validation of our efforts. These metrics have the most weight because they're the ones that matter most to healthcare providers."
Christopher Cheney is the senior clinical care editor at HealthLeaders.