Today we released the first of our quarterly reports. The goal of the Verden rankings system is to evaluate how well or poorly managed care companies (Payers) are performing from the perspective of physician practice management. The data used to rank these Payers comes directly from the companies themselves, as gathered by the Verden Alert subscription service. This service monitors insurer sites for any policy and procedure changes and alerts subscribers based on their participation and specialty whenever changes are posted.
Not all Payers are created equal and the cost of doing business with some will be much higher than others. Our purpose in analyzing this data was to take a look at which companies are relatively efficient at managing their networks, and which ones simply move administrative burden to the providers’ plate.
Our analysis is composed of five categories in which each insurance company was given a score. The more points accumulated, the worse the company fared. Data selected for measurement were those with an effective date occurring between 01/01/2008 and 03/31/2008 (Q1 2008).
1. Cost to Provider (CP)
Cost to Provider takes into account policy changes or initiatives affecting reimbursement, and those that added more or less administrative time or complexity to a process in order to adhere to changes. Examples include implementation or withdrawal of pre-authorization, precertification, notification, and referral processes; timelines or modified processes that require more or less resources in order to comply with changes; and claims, coding or data errors or improvements resulting in more or less efficiency. These points accounted for 50% of the aggregate score.
2. Volume of Change (VC)
Volume of Change takes into account the total amount of policy and procedure change across all categories – medical, administrative, pharmacy and reimbursement – experienced by an insurer’s network.
3. Clarity of Communication (CC)
This indicates how well or poorly insurers make information available on their web sites. These days, most insurers utilize their web sites as their primary communication tool for notifying network participants of changes to policies and procedures. The expectation is that providers will monitor these sites for updates in order to keep themselves informed as part of their contractual obligations with an insurer. Measures include whether insurers’ clearly identify a new or modified policy, its effective date, and what change occurred. The easier it is to find medical policies and updates on the site, the fewer points accumulated. Penalties go to insurers that keep their policies and network news behind a log in barrier.
4. Notification Period (NP)
NC measures the time that elapses between posting notification of a policy or procedure change and the date upon which the change became effective. We graded insurers on how much notice they gave providers of their intent to change a policy or procedure – the less time between posting and effective date, the higher the score. We believe that at least thirty days of notification is necessary for providers to respond and adapt to the change, and those insurers that post 30 days ahead of effective date accumulate no points.
5. Posting Integrity (PI)
PI measures policies posted on-line with a retro-active date, or policies altered without an update or revision date being added. Tracking insurers’ web sites every day allows us to see when notifications have been back-dated or altered. Because we view this practice as highly deceptive we allocated a separate metric to this issue and insurers observed retro-posting or altering information without notification are tagged with a penalty score.
Of the 160+ insurance companies the Verden Group tracks on a national basis, eighteen companies made the list for our first ranking. We based this decision on robustness of data gathered within the defined time period. Look for additional Payers in future quarterly listings.
Aetna came out of ahead of its competitors by a large margin overall. It scored the best in the Clarity of Communication and Cost to Provider categories. Humana was found to be the costliest of the networks measured, while Anthem and UnitedHealthcare tied with the highest volume of change to manage. HealthNet is the worst for notifying its network of changes ahead of time, while Oxford scored the best in this category. UnitedHealthcare was the only Payer to receive penalty points this quarter for posting integrity occurrences.
Go here http://www.theverdengroup.com and click the green banner to access the full report.