Physician Survey on Payers

By August 30, 2012 Commentary

Revive Health issued results from a survey of hospital executives responsible for managed care contracting regarding their perceptions of payers. About 35% of hospitals responded.   (Revive Health Survey)   Of the respondents, 94% contract with UnitedHealth, 89% with Aetna and Cigna, 75% with an independent Blue Cross plan, 74% with Humana and 49% with Wellpoint.   Independent Blue Cross plans account for the largest portion of revenue, followed by Wellpoint and UnitedHealth.  The hospitals highest priorities are to increase rates and to protect against denials.  In terms of overall favorability, Cigna is tops at 71%, followed by Aetna at 60%.  Wellpoint lags at 27%.  The independent Blue Cross plans are said to have the worst payment rates by 27% of hospitals and UnitedHealth by 21%.  Aetna is reported as having the best by 19% and the independent Blue Crosses by 18%.  The most hospitals report the worst plan for paying quickly is UnitedHealth, although great improvement is reported .  The best are the independent BC plans, followed by Aetna and UnitedHealth.

Hospitals believe reform will result in a decrease in private payer rates.  About half report some interest in an ACO.  Over half say they are already engaged in some form of population health management program.  Three-quarters say they either have or are planning to engage in more clinical integration with physicians and other providers.  A surprising 40% either are or are going to engage in direct contracting with employers.  Almost two-thirds have at least one contract with quality criteria in it, but most don’t feel they are really well-prepared to handle that type of contract.  Contracting disputes with payers are very common.  Most hospitals are expecting hefty rate increases, well above the rate of general inflation, with almost 60% saying they will be 4-7%.  While hospitals paint a bleak picture of their financial future, most look they are doing pretty well and they are clearly still driving general health spending increases.  And many of their complaints about payers are things that the payers, and the patients they reimburse for, should be happy about–keeping rates low.

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