Aetna, Cigna Rank Highest in Efficiency

By HEATHER WON TESORIERO
http://online.wsj.com

[chart]Aetna Inc. ranked first among more than 130 big health insurers in how quickly and accurately they reimburse doctors, based on factors such as how long carriers take to pay bills, the percentage of claims they resolve after one submission and their claim-denial rates.

The rankings, expected to be released Thursday, offer a snapshot of insurer responsiveness based on data from some 13,000 clients of Athenahealth Inc., which provides doctors with practice-management and electronic medical-record services. While some insurers dispute the accuracy of the findings, many said it provides a reasonably accurate performance estimate.

The annual ratings, which Athenahealth began compiling three years ago, reflect a greater push toward performance measurements and transparency across the health sector. A 2007 survey of hospital executives and insurers by PNC Financial Services Group Inc. found that administration and billing account for one of every $3 spent on health care in the U.S.

Athenahealth weighted seven criteria to assess which carriers were most responsive. Aetna took 27 days on average to pay doctors, resolved 96% of claims on the first attempt and denied 5.9% of claims — the three factors given the most weight — to finish with the best overall score. Cigna Corp. finished second overall, taking 33 days on average to pay doctors, resolving 96% of claims in one attempt and denying 6.6% of them. New York state’s Medicaid program scored the lowest among all payers in the study: The joint federal-state insurance program for the poor took 137 days on average to pay doctors, resolved 57% of claims on one try and denied 39% of claims.

Aetna has improved year over year since the rankings were first published. In the 2006 ranking, the insurer paid doctors within 32 days on average, resolved 87% of claims after one submission and had a denial rate of 5.9%. An Aetna spokesman said the company has improved efficiency, in part, through technology and by clarifying its policies with doctors.

Cigna spokesman Joe Mondy said the company improved in some areas, including first-try claims resolution. Cigna said Athenahealth’s ratings are a bellwether of insurer performance.

New York state Department of Health spokesman Jeffrey Hammond said the agency hadn’t had a chance to review Athenahealth’s methods. According to the state’s calculation, Medicaid’s claim-denial rate is 24%. He said the 39% figure suggests the doctors who are in the Athenahealth network are doing far worse than the broader pool of doctors in the state’s program.

William F. Jessee, chief executive of Medical Group Management Association, an organization for individuals who manage medical-group practices, said persistent delays in payment often prompt doctors to drop out of insurance plans, which can lead to reduced access to care for patients.

Write to Heather WonTesoriero at heather.tesoriero@wsj.com

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