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Practice Perspectives on Payer Performance, 2009

The Medical Group Management Association (MGMA) has conducted its second annual poll to determine group practice professionals' attitudes about payer interactions. This year’s questionnaire focuses on seven large payers; Aetna, Anthem, CIGNA, Coventry, Humana, Medicare Part B and UnitedHealthcare. More than 1,700 practice professionals participated in the poll. Results reflect the members’ perceptions of the payer environment in areas of payer communications, provider credentialing, contracting, payment policies, system transparency and overall satisfaction.

MGMA is the representative of group practices that are major suppliers of physician services for those health plans. As such, we look forward to payers reflecting on these results and working with us to create solutions in the areas identified as needing improvement. The results speak for themselves; it is our goal that all plans – public and private – achieve positive satisfaction scores from MGMA members on all of these key administrative functions.

Results

*Shading indicates averages greater than 3.

Expanding Item - View MoreOverall Satisfaction

Expanding Item - View MoreWhat is your overall current satisfaction with the payer?

Ranking

Payer

Rating Average

1

Medicare Part B 

3.59

2

Aetna 

3.14

3

CIGNA 

3.11

4

Coventry 

2.99

5

Humana 

2.92

6

Anthem 

2.84

7

UnitedHealthcare 

2.45


Based upon a 5 point scale where 1= Completely dissatisfied, 2=Moderately dissatisfied, 3=Neutral, 4=Moderately satisfied, and 5=Completely satisfied.

Expanding Item - View MorePayer Communications

Expanding Item - View MoreHow satisfied are you with the amount of time it takes the payer to respond to your questions?

Ranking

Payer

Rating Average

1

Medicare Part B 

3.48

2

Aetna 

3.16

3

CIGNA 

3.15

4

Coventry 

3.00

5

Humana 

2.96

6

Anthem 

2.79

7

UnitedHealthcare 

2.49


Based upon a 5 point scale where 1= Completely dissatisfied, 2=Moderately dissatisfied, 3=Neutral, 4=Moderately satisfied, and 5=Completely satisfied.

Expanding Item - View MoreHow satisfied are you with the accuracy and consistency of the payer's responses to your questions?

Ranking

Payer

Rating Average

1

Medicare Part B 

3.47

2

Aetna 

3.17

3

CIGNA 

3.17

4

Coventry 

3.01

5

Humana 

2.98

6

Anthem 

2.83

7

UnitedHealthcare 

2.56


Based upon a 5 point scale where 1= Completely dissatisfied, 2=Moderately dissatisfied, 3=Neutral, 4=Moderately satisfied, and 5=Completely satisfied.

Expanding Item - View MoreProvider Credentialing

Expanding Item - View MoreHow satisfied are you with the provider credentialing process?

Ranking

Payer

Rating Average

1

Aetna 

3.31

2

Anthem 

3.28

3

CIGNA 

3.28

4

Humana 

3.21

5

Coventry 

3.17

6

UnitedHealthcare 

2.98

7

Medicare Part B

2.95


Based upon a 5 point scale where 1= Completely dissatisfied, 2=Moderately dissatisfied, 3=Neutral, 4=Moderately satisfied, and 5=Completely satisfied.

Expanding Item - View MoreContracting

Expanding Item - View MoreHow much leverage does your practice have during the contract negotiation process?

Ranking

Payer

Rating Average

1

Aetna 

2.24

2

CIGNA  

2.18

3

Coventry 

2.17

4

UnitedHealthcare

2.11

5

Humana 

2.09

6

Anthem 

1.96


Based upon a 5 point scale where 1= No leverage, 2=Slight leverage,
3=Moderate leverage, 4=Considerable leverage, and 5=Completely leverage.

Expanding Item - View MoreHow satisfied are you that the payer conducts 2-way, good-faith negotiations during the contracting process?

Ranking

Payer

Rating Average

1

Aetna 

2.70

2

CIGNA  

2.65

3

Coventry 

2.60

4

Humana 

2.55

5

Anthem 

2.39

6

UnitedHealthcare 

2.32


Based upon a 5 point scale where 1= Completely dissatisfied, 2=Moderately dissatisfied, 3=Neutral, 4=Moderately satisfied, and 5=Completely satisfied.

Expanding Item - View MoreHow willing is the payer to disclose the fee schedule used to reimburse your practice under the terms of your contract?

Ranking

Payer

Rating Average

1

Medicare Part B

4.45

2

Aetna  

3.52

3

CIGNA 

3.47

4

Coventry 

3.42

5

Humana 

3.38

6

Anthem

3.37

7

UnitedHealthcare 

3.33


Based upon a 5 point scale where 1=Completely unwilling, 2=Moderately unwilling, 3=Neutral, 4=Moderately willing, and 5=Completely willing.

Expanding Item - View MorePayment Policies

Expanding Item - View MoreHow satisfied are you that the payer fully discloses its payment policies? 

Ranking

Payer

Rating Average

1

Medicare Part B

3.86

2

Aetna  

2.91

3

CIGNA 

2.90

4

Humana 

2.80

5

Coventry 

2.79

6

Anthem

2.77

7

UnitedHealthcare 

2.61


Based upon a 5 point scale where 1= Completely dissatisfied, 2=Moderately dissatisfied, 3=Neutral, 4=Moderately satisfied, and 5=Completely satisfied.

Expanding Item - View MoreHow satisfied are you with the claims appeals process? 

Ranking

Payer

Rating Average

1

Medicare Part B

3.21

2

CIGNA 

2.80

3

Coventry 

2.71

4

Humana 

2.63

5

Anthem

2.54

6

UnitedHealthcare 

2.25


Based upon a 5 point scale where 1= Completely dissatisfied, 2=Moderately dissatisfied, 3=Neutral, 4=Moderately satisfied, and 5=Completely satisfied.

Expanding Item - View MoreHow satisfied are you with the promptness of claims payments?

Ranking

Payer

Rating Average

1

Medicare Part B

4.11

2

Aetna  

3.50

3

CIGNA 

3.39

4

Anthem

3.22

5

Humana 

3.21

6

Coventry 

3.19

7

UnitedHealthcare 

3.11


Based upon a 5 point scale where 1= Completely dissatisfied, 2=Moderately dissatisfied, 3=Neutral, 4=Moderately satisfied, and 5=Completely satisfied.

Expanding Item - View MoreRating System Transparency

Expanding Item - View MoreHow transparent to you are the cost and quality measures used by the payer for its physician rating and/or pay-for-performance programs? 

Ranking

Payer

Rating Average

1

Medicare Part B

2.88

2

Anthem

2.14

3

Aetna  

2.06

4

CIGNA

2.03

5

Coventry  

2.03

6

UnitedHealthcare 

2.03

7

Humana

2.01


Based upon a 5 point scale where 1=No transparency, 2=Slight transparency, 3=Moderate transparency, 4=Considerable transparency, and 5=Complete transparency.

Note: The Practice Perceptives on Payer Performance study depended on voluntary participation by MGMA members.  While the profile of the respondents is comparable to MGMA’s overall membership, the results of the study may not be representative of all U.S. medical practices.

Read the press release about the study

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