The Verden Group’s latest ranking of health plans is out, and there’s a bit of turnover at the top.
For those unfamiliar with the Verden Report, it evaluates how well or poorly managed care companies/health plans are doing from the providers’ perspective. It tracks changes to policies regarding pre-certification; reimbursement; claims filing, processing and problem reporting; eligibility verification and other provider-payer ‘interaction’; the volume, timing and communication about those changes, and the accuracy of that communication.
In brief, the Report reports how well, or poorly, payers are treating providers. The Report is very useful, particularly in monitoring healthplans’ relations with providers overall. Healthplans that consistently rate at the bottom end of the scale are going to have a tough time expanding; likely cause themselves, and their insureds, a good deal of agita due to avoidable confusion about healthplan process/policy changes; and I’d argue don’t have a good grasp on one of the essential components of a successful long term strategy – good provider-payer relations.
I emphasize evaluating health plan performance over the long term. From time to time any health plan is going to look ‘bad’ (or at the least not as good as they usually do) because they will have to implement a number of provider-facing changes around the same time.
As an example, look at Aetna’s history (at the top throughout 2008) compared to their current position (fourth). The big healthplan announced a lot of changes (relative to the earlier volume) – but the clarity of their communications about those changes was quite good – best in the industry, in fact.
On another note, New England’s Fallon Community Health Plan was well below average due to significant changes in the list of procedures subject to utilization review. Although Fallon removed ‘a bunch of pre-authorizations on injections and drugs”, Fallon added a pre-cert requirement for more expensive services including kyphoplasty.
This last is why you need to read the report and not just the rankings. Without getting too far into the details, kyphoplasty, a minimally-invasive surgical procedure intended to alleviate spinal compression, is one of those newish procedures that offers minimal – if any – improvement over older, more established techniques.
It is a good thing that Fallon is tightening up standards for approval of this procedure. Even if it adds to providers’ workload.
Jun
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