Health Execs Name Worst and Best Payors
The annual ReviveHealth survey of hospital and health system executives' thoughts on payors is out and once again, WellPoint/Anthem was considered the worst payor to deal with while BlueCross BlueShield (BCBS) was viewed most favorably. BCBS was rated highest on all factors except for the rates they pay providers. The 373 execs surveyed rated Aetna highest on that dimension. Cigna, which was rated highest last year, was also a top company this year. The report also identified 6 macro trends among payors. They are:
- Risk shifting — Moving more of the risk onto patients and providers, which is increasing medical bankruptcy and bad debt held by providers. Consolidation, especially among the Blues as they position themselves to compete more effectively against publicly traded companies.
- Vertical Integration — Payors are increasingly buying up primary care groups and hospitals.
- Dominance — Decreasing competitive pressure by becoming the single largest payor in various local markets.
- Obfuscation — Using intentionally vague and misleading language in informing patients about their contract negotiations with providers and shifting the blame for rising costs onto providers.
- Exchanges — According to the report, the health plans are re-engineering their business models, product offerings, and sales pitches to become players in the Affordable Care Act’s health insurance exchanges. The majority of these exchanges will be run by the federal government. Just 17 states will run their own exchanges.