Brandon Edwards

WellPoint/Anthem has replaced United Healthcare as the nation’s worst health plan, according to hospital representatives in 50 states.

That’s the consensus of hospital and health system administrators responsible for negotiating contracts with major health plans in the sixth annual National Payor Study. Conducted by Nashville-based ReviveHealth, the 2012 survey, “Turning the Corner Toward 2014,” paints a broad picture of administrators’ opinions about various private payors, including rates, payment of claims, denials and other actions. The summary also assesses opinions on accountable care organizations (ACOs), clinical integration, and other issues facing the medical community as the pivotal presidential election draws near.

“WellPoint/Anthem has developed a reputation as the worst health plan in the U.S.,” said Brandon Edwards, president of ReviveHealth. “Bad reputation is driven by business practices and corporate behavior. This is the first time they’ve been ranked worst.” 

One reason why it’s surprising to see WellPoint on the bottom: they only own plans in 14 states, said Edwards, yet over the past year, WellPoint has been involved in five times more public disputes than all other Wall Street payors combined.

“United Healthcare is improving, but only by baby steps, with a long history to repair,” he said. “The first year we did the survey, we thought there was a mistake because United Healthcare ranked so poorly. It was very bad back then! The first couple of years, we saw small improvements. In 2011 and 2012 surveys, United Healthcare made more significant improvements. The gap between United Healthcare and the group of plans above them has narrowed substantially.”

Blue Cross Blue Shield (BCBS) also garnered attention in the survey. Noting that the BCBS Association requires Blues plans to maintain a risk-based capital of 375 percent or approximately $20 billion, Edwards said that since 2003, Blue Cross plans have held, on average, more than double the required amounts, and in recent years, nearly triple.

Edwards also pointed out that Blues plans are following the same playbook as WellPoint/Anthem, therefore applying tremendous pressure to hospital rates. 

Beyond rates, independent Blues plans are viewed as “decent payors,” based largely on prompt payment and a low rate of claims denials, he noted.

“No independent BlueCross plan is going to be the single worst plan in the country because they’re focused in those markets,” said Edwards. “The real question is: who’s considered the worst-ranked plan by market? In Arkansas and North Carolina, in particular, we saw very heavy negativity from the hospital community toward Blues plans around contract language and business practice issues. In those two states, they are the worst overall.”

In Florida, Louisiana and Tennessee, Blues plans are dominant but not worst-ranked, said Edwards.

“They may not be loved, but I find it interesting that hospitals are willing to acknowledge the good qualities of any plan,” he said. “They may say Blue pays me poorly, but they pay me promptly and there aren’t many denials, delays, or other games. They’re willing to be honest rather than have the overall poor pay color their responses.” 

Also on the forefront of survey respondents: how the outcome of the presidential election will make a difference in the health reform climate.

“It’ll no doubt impact how healthcare is delivered,” said Edwards. “If you believe what you read in the Wall Street Journal, New York Times and other major publications, Obama’s loss could lead to repeal or partial repeal or effective repeal by defunding some of the initiatives. All managed care companies’ stock would drop and they would be under significant financial pressure. Conversely, if those companies are challenged, one would believe the environment might improve for hospitals.”

Survey data was collected from February through June from 403 interview respondents, representing 35 percent of the nation’s hospitals, up from 28 percent last year. 

Editor’s Note: This article marks the first in a 2-part series summarizing Nashville-based ReviveHealth’s sixth annual National Payor Study. In November, Medical News will focus on survey results beyond the rankings.

• Alabama has the single-most dominant BlueCross BlueShield (BCBS) plan in the nation. “In Alabama and Florida, Blues plans are in the midst of high-profile, anti-trust litigation that challenges the method by which they’ve built and maintained their monopoly power in those markets,” said Brandon Edwards, president of ReviveHealth.
• In Arkansas, BCBS has 75 percent of the commercial market share.
• In North Carolina, BCBS has 70 percent of the market share.
• In Florida, Louisiana and Tennessee, BCBS plans have more than half of the market share.
• In Tennessee, there weren’t enough sample sites to say specifically how metro areas compared. “Looking at Tennessee overall, how Blue may be seen in Memphis v. Nashville v. Chattanooga could be very different,” he said.
• St. Louis, Mo., is the only Medical News market with an Anthem-owned plan.
• Kentucky has a more competitive insurance environment. “We didn’t see Blue being ranked as the worst plan overall there,” said Edwards. “While WellPoint ranked worst overall, they weren’t ranked worst, either. In fact, the rankings between United Healthcare and WellPoint were almost identical.”

SOURCE: ReviveHealth.