Pay-for-performance has long been hailed as a means of curtailing physician costs and improving patient care.
The idea is that with the increasing integration of IT, it will make it more possible to track any number of indicators of physician competence and to remunerate that health care provider accordingly.
But a new ranking of health care insurers in Texas has taken that concept and stood it on its head.
These state-level rankings measure how favorably health insurers deal with physician offices. They were recently released by Athenahealth, a medical practice revenue management software maker.
Metrics analyzed included the average length of time it takes a health plan to pay a claim, the percentage of claims that get paid in full the first time submitted, the average portion of the bill deemed to be the patients responsibility, rate of claims denials and the percentage of claims requiring clarifying phone calls by physician office staff.
The analysis found that Medicare was the least likely health plan to deny patient claims, with about 6 percent denied. Medicaid, however, rejected more claims than any other insurer—almost one-quarter of patient claims. Among private health insurers, Humana and Aetna were the fastest at turning around payment, averaging about 30 days.
It was based on performance data for more than 330 Texas health care providers in 59 medical practices in an Athenahealth database.
In the second quarter of 2006, these sources provided more than 295,000 charge lines for that period.
Only government and private payer organizations with a minimum of 1,500 charge lines were included in the analysis.
Last summer, Athenahealth released national payer rankings. These new, more nuanced analyses of health payer activity by state, however, are likely to give physician practices greater insight into health payer patterns that are often regional.
"Transparency continues to be one of the dominant themes in health care today," said Todd Park, co-founder and chief development officer of Athenahealth.
"And yet for the insurer there is virtually no actionable apples-to-apples data available to measure how well or poorly they perform one of their primary functions—paying for health care."