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TECH/HEALTH PLANS: AthenaHealth causing trouble again

AthenaHealth caused a ruckus last year when it put out  a ranking of how fast health plans were paying doctors. Now they’re at it again. Cigna ranked No. 1 and United didn’t do so well. Of course if just speed of payment were the problem in American health care, it would have been fixed long ago.

But surely there’s much else in their data that would be interesting to know about. For example, I’m looking forward to AthenaHealth telling us from its data what activities of its physician customers were appropriate given their patients’ conditions. I’m interviewing AthenaHealth CEO Jonathan Bush in a few days, and I’ll ask him about that.

Any other suggested questions?

UPDATE: Here’s the chart of AthenaHealth’s 2007 Payerview rankings. They’ve also put up a rather flashy website explaining it all.

PAYERVIEW NATIONAL PAYER RESULTS:

National Payer 2007 Rank 2006 Rank
CIGNA Healthcare 1 5
Aetna 2 4
Medicare – B 3 2
Humana 4 1
UnitedHealth Group 5 3
Wellpoint 6 7
Coventry Health Care 7 Not ranked
Champus/Tricare 8 6

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5 replies »

  1. Scott,
    I’m sorry, but your characterization of the current discourse as “slamming AthenaHealth” seems disengenuous.
    Aside from that, although the window of opportunity to suggest input to the interview with Jonathan Bush is gone, I am curious as to anyone’s speculation on the significant shifts between health plan ratings from 2006 and 2007. (e.g. In 2006, Human ranked 1st. In 2007 it dropped to 4th place.)
    In reference to Brian’s idea about access to health claim information, I suspect that data is not readily accessible due to concerns about patient health information privacy. Although in theory it should be possible to extract the diagnostic, procedural, and provider identification coding in order to create bulk results, the whole idea is enough to make a lot of the people involved sweat in their skivvies.
    On the other hand, if you could get a serious groundswell of health care consumer support for such an effort, I believe the whole “system” would benefit from the increase in transparency.

  2. WOW. This site applauded BCBS of Minnesota for creating a “nutritional” chart for providers that essentially ranked providers based on cost and quality/level of care. Now this site is slamming AthenaHealth for putting data together that creates some transparency for insurers. Tisk, tisk.

  3. I suspect that AthenaHealth would be unwilling to publicly report physician performance. Who wants to antagonize their clients?
    But if AH has access to the information within the individual claims records, it could add significant additional value by discretely providing physicians with their relative performance values and performance benchmarks. Physicians could use this information in health plan negotiations and to guide performance improvements that will become increasingly important as P4P takes root. At this point, the only data most doctors have access to during contracting are the numbers the health plans give them.
    While health plans have actively campaigned for provider performance transparency, their own performance has remained fundamentally opaque. If this continues, it will render the changes possible through P4P – which changes the incentives to reward the right care instead of simply more care – much more difficult to achieve, because providers inherent distrust will bubble over, as it did with managed care. After all, if I’m not willing (or able) to tell a physician or hospital what utilization or cost changes resulted from the incentive shift, or how the savings were distributed, the conclusion will be that the health plan simply pocketed the dollars with no savings to the system.
    In this sense, AthenaHealth has taken a major step forward in precipitating health plan transparency, and they deserve our collective thanks.
    That said, its useful knowing how long it takes for plans to pay claims, but hardly what’s required to fully understand health plan performance. A more robust tool is eValue8 (www.evalue8.org), developed by the National Business Coalition on Health (www.nbch.org). This last October, the Florida Health Care Coalition performed an evalue8 analysis of major health plans operating in Florida and then released the results. These tools finally begin to provide a credible method for purchasers and providers to get a handle on the complex, confusing workings of health plans.
    If AthenaHealth could leverage their resources a little further by broadening their analysis, they’d add real value to changing the dysfunction that plagues this part of the system.

  4. I too would be interested in a breakdown of diagnostic, procedure and pharma reimbursements. I suspect we know what we would find. Mr. Bush is sitting on some valuable info. See if you can pry a few nuggets out of him. 😉

  5. Along the same lines as your question, I am curious as to the variance among doctors in risk adjusted utilization. How much is there and to what extent does it relate to defensive medicine, desire to make money from doctor owned diagnostic equipment, excessive caution or some other factor? Also, how much upcoding is there that insurers should be challenging? Any thoughts on the magnitude of fraud?

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