Insight, analysis & opinion from Joe Paduda

< Back to Home

Mar
26

Providers rating health plans

There is a growing movement on the part of providers that is turning the tables on health plans. Providers have long objected to profiling, ranking, and rating as done by health plans, complaining (with and without justification) that the systems/algorithms used were inaccurate, unfair, superficial, and/or misleading.
Now providers are giving health plans a taste of their own medicine, and for United Health, it is bitter stuff indeed.
One of the first surveys that evaluated providers’ opinions of health plans was the survey conducted by the Verden Group. Their Q4 ratings of health plans is out, and once again Aetna is looking good. The rankings are driven by providers’ views of health plans, the complexity and difficulty of their interactions with health plans, and plans’ tools and processes that affect providers. Reimbursement policies are also factored in, as is the cost to the provider of complying with health plan policies.
While the report does not include all health plans, it does cover around forty of the largest.
There is always movement up and down the ratings scale, but Aetna is consistently at or near the top. Other plans seem to bounce around due to changes in reimbursement policies, more or less onerous prior authorization requirements, changes in ease of access to patient eligibility and medical record information – with jumps up or down the rating scale commonplace. The lowest score wins in the Verden scale; Aetna is the only plan to not only score in the single digits in Overall Rankings, but to do so every quarter.
Health plans that partner with providers – provide ready access to eligibility data, reduce the administrative burden of pre-certs and appeals, pay quickly, minimize policy/process changes so providers aren’t constantly confused about the current requirements, and add value in the form of access to member medical data are going to do much better over the long term.
A hospital-focused survey was just released, and it confirms Aetna’s leadership position. United HealthGroup is at the bottom of the rankings (it is towards the bottom in the Verden survey, although one of its operating units, (Oxford) is ranked quite high. The survey was conducted by Davies Public Affairs, identified a sharp differences between the ‘best’ and worst plans. Here’s how they put it:
“For the first time, the survey revealed a preferred partner for hospitals and physicians. Aetna received a 64% favorable rating (compared to a 34% unfavorable rating), which was 9% better than CIGNA, the second-best rated plan and a full 48% better than the worst rated plan, UnitedHealthcare. The survey reveals a strong preference from hospitals based on trust, honesty, business practices and good faith negotiations.
“Aetna is clearly the preferred health insurance partner for hospitals and health systems across the United States,” said Brandon Edwards, President/COO of DAVIES. “When you combine this survey data with recent publicly traded health plan earnings announcements, it’s clear that provider trust and satisfaction are leading indicators of organic membership growth. This bodes well for Aetna, and perhaps CIGNA, as they look at 2009 commercial enrollment retention, as well as 2010 commercial enrollment growth.”
The survey revealed that 82% of respondents indicated an unfavorable opinion of UnitedHealthcare, {emphasis added] which is actually an 8% improvement for them over last year. This contrasts with an average unfavorable rating of 34% among all other insurance companies in the survey.”
It gets worse.
“One striking finding is that UnitedHealthcare was not the largest payor in terms of revenue for the average hospital, and its reimbursement rates were not significantly lower than other major health plans. UnitedHealthcare is paying as much or more than other insurance companies for healthcare services but they are viewed as the worst performer by a large margin. [emphasis added] The survey makes clear that dissatisfaction is driven by distrust, dishonesty, flawed business process, inadequate claims processing, claims denials and other business process problems.”
I was excited when the company I worked for – MetraHealth – was acquired by UHG fourteen years ago. At the time United was the most respected health plan company and was seen as the model that others would aspire to. After working for United for a couple years, I had to leave. My sense was ‘if this is the best health plan out there, I’ve got to stop working at health plans.’
Looks like nothing’s changed.
The full Davies survey is here; the Verden Quarterly Report is here.


2 thoughts on “Providers rating health plans”

  1. The relationship between insurers and providers is inherently adversarial while the doctor-patient relationship is not. I think that’s a key difference which needs to be considered when assessing evaluations.

  2. Next week, I’m meeting with a VP from one of our health plans to talk about improving the relationship with our medical group. Joe – you’ve been on the health plan side. Do you have any input on what should be discussed in that meeting?

Comments are closed.

Joe Paduda is the principal of Health Strategy Associates

SUBSCRIBE BY EMAIL

SEARCH THIS SITE

A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.

 

DISCLAIMER

© Joe Paduda 2022. We encourage links to any material on this page. Fair use excerpts of material written by Joe Paduda may be used with attribution to Joe Paduda, Managed Care Matters.

Note: Some material on this page may be excerpted from other sources. In such cases, copyright is retained by the respective authors of those sources.

ARCHIVES

Archives