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Evolving Transparency

Athenahealth is a prominent provider of EHR and claims processing for physicians, and also runs an annual project dubbed PayerView. The project centralizes every piece of data from their network of nearly 24,000 providers in order to quantify and rank metrics on public and private payers such as claims denial percentage, patient eligibility checks, and days between services charge and actual payment. This year saw a significant reduction in denials (except for the Blues) with faster payments to providers.

It is precisely this type of transparency that will drive competition and innovation in the marketplace, which will make providers lives a lot easier while shedding a light on cost-containing efficiencies (or lack thereof) in the system. And health reform will vastly improve this evolution; while the PayerView project assesses provider-payer interactions, the Exchanges will also include customer-related metrics like satisfaction, price, medical loss ratio, and benefit design to create a ‘triangle’ of transparency between the patient, the health care provider, and the health plan.