Massachusetts hospitals rate state health plans

Massachusetts hospitals have become the latest industry group to turn the tables on health plans and rate their performance systematically. The Massachusetts Hospital Association has released a report card on the administrative practices of health plans serving hospitals in the state, with coding cited as perhaps the biggest problem the facilities face.

To conduct the study, the MHA surveyed executives from 31 member hospitals, including 17 acute-care facilities with inpatient psych units, 10 acute care hospitals with no inpatient psych units, two non-acute care hospitals and two private psych hospitals. The study asked the executives to rate the performance of 12 health plans on claims payment, member education, authorization processes and utilization management.

All told, coding stood out the most as a headache for the hospital execs. Another big pain point was health plans' increasingly common pre-authorization programs for radiology, respondents said.

Looked at as a whole, there were few broad trends, other than that national plans like Cigna, Aetna and United Healthcare received lower marks than local plans. But execs did point out key concerns related to some plans. For example, Blue Cross, Blue Shield plans didn't score highly on measures related to utilization management for surgical admissions.

To learn more about this data:
- read this Healthcare Finance News piece
- read the MHA report (.pdf)

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