ReviveHealth and Catalyst Healthcare Research, along with special guest athenahealth, reveal the findings from our 9th Annual ReviveHealth National Payor Survey of health system executives and discuss how those findings compare and contrast with the 10th Annual athenahealth PayerView report. In this 60-minute webinar, athenahealth Payer Operations Manager Laurie Graham, ReviveHealth CEO Brandon Edwards, and Catalyst Healthcare Research President Dan Prince will address the following essential questions: How do payors stack up against each other in terms of trust, reliability, honesty, and fairness? How does a payor’s denial rate and claims speed inform provider trust? What strategies are providers and health systems implementing for continued success in the changing healthcare environment? What are the major trends in the healthcare industry?

1. 2015 National
Payor Survey
MAY 2015
2015 PayerView®
Payer Rankings

2. Brandon Edwards
CEO
ReviveHealth
thinkrevivehealth.com
Dan Prince
President
Catalyst Healthcare Research
catalysthcr.com
Laurie Graham
Payer Operations Manager
athenahealth
athenahealth.com

3. 2015 PayerView®
athenahealth Inc. Payer Rankings
May 19, 2015

4. 3,900 employees
$595 million in revenue
9 locations
59,000 medical providers
$11.7 billion in client collections
98 medical specialties
Introduction

5. athenahealth is a company with
tremendous purpose

6. PayerView looks under the hood at payer
performance on the athena network
4

7. PayerView Goals and Objectives
Leverage network insight
Provide evidence-based insight on payer performance to help
practices respond to industry trends. Empower athena providers with
a comparative tool that characterizes the ease or difficulty of doing
business with given payers.
Discover areas for continuous improvement
Continuously discover and refine metrics that accurately reflect
the dynamics that create inefficiency and cost across the
healthcare supply chain.
Inject transparency for collaboration
Use the data as a framework to inform initiatives aimed at
creating transparency between providers and payers.
Goals and ObjectivesConfidential

8. 2015 evaluates the largest sample of payers
of any previous year of PayerVIew
PayerView Sample
PayerView rankings are derived from activity within the athenaNet® database.
2012 2013 2014 2015
Providers 32,000 39,000 47,000 59,000
Charge lines 65M 83M 108M 145M
Charges $12B $15B $20B $28.5B
States 41 41 49 50
Payers 138 138 148 166
Methodology
1. Payer Definition: Each payer in PayerView is a recognized a health insurer as defined by athena.
2. Volume Thresholds: Providers must submit a minimum volume claims to be included in PayerView
3. Client Representation: A minimum of six athena clients live for 90 days must submit to any given payer.
No one provider can contribute more than 50% of claim volume to a particular payer.
Confidential

9. Payers are evaluated for financial, administrative
and transactional performance
METRIC WT. DESCRIPTION
Financial
Performance
Days in Accounts
Receivable
20%
Average length of time it takes for a provider to receive payment
for services.
First Pass Resolve Rate 15%
Percentage of claims that are successfully resolved on the initial
submission.
Provider Collection
Burden
10%
Percentage of charges ($) transferred from the primary insurer to
the next responsible party.
Administrative
Performance
Denial Rate 15% Percentage of claims requiring back-end rework.
Enrollment Efficiency 5%
Quantitative ranking of administrative burden surrounding
provider enrollment in electronic transactions.
Enrollment Turn-
Around-Time
5%
The number of days required for a payer to return an enrollment
request.
Transaction
Performance
Electronic Remittance
Advice Transparency
10%
Percentage of electronic remittance advice (835) denial
messages with actionable explanations and clear next steps.
Eligibility Accuracy 10% Correlation of eligibility response to adjudication outcome.
Benefit Reliability 10%
Percentage of patient responsibilities in which payer returned the
correct and actionable patient responsibility information through
eligibility at the time of service.
Overall Score 100% The overall score reveals payer ranking
Methodology
PayerView Measures
The same nine metrics are used in 2014 and 2015 for accurate comparisons

10. 2015 Rankings

11. Top Payers in 2015
2014 2015 Payer
2 1 HealthPartners
5 2 Group
Health
Coopera4ve
1 3 Humana
48 4 BCBS
–
WA
Regence
-­‐ 5 Maryland
Physicians
Care
MCO
3 6 BCBS
–
MA
21 7 BCBS
–
LA
7 8 BCBS
–
PA
Capital
Blue
Cross
15 9 BCBS
–
NC
17 10 BCBS
–
NC
Blue
Medicare
Top Rankings
Out of 166 payers, small, regional, commercial plans and blues
plans dominate the Top 10.
• HealthPartners (Non-Profit, MN),
Group Health Cooperative(Non-
Profit, WA) move into winning
ranks.
• Humana and BCBS-MA continue
to perform well and remained in
the Top 10 for 2014.
• Maryland Physicians Care MCO
(Managed Medicaid, MD) ranks
#5 in its debut year.
• This year, the payer mix is highly
representative of the market. Co-
Ops, as well as health plans
offered by integrated delivery
systems, such as UPMC and
Maryland Physician Care MCO,
were evaluated and prove to
perform as well as some top
Commercials.
Confidential

12. National Payer Performance in 2015
Final
Rank PayerView
2011
PayerView
2012
PayerView
2013
PayerView
2014
PayerView
2015
1 Aetna Humana Humana Humana Humana
2 Humana Aetna Aetna Cigna Aetna
3 United United United Aetna Cigna
4 Cigna Cigna HCSC Medicare-­‐B Medicare-­‐B
5 HCSC Medicare-­‐B Medicare-­‐B United Champus-­‐Tricare
6 Wellpoint Wellpoint Wellpoint HCSC HCSC
7 Medicare-­‐B HCSC Cigna Wellpoint United
8 Champus-­‐Tricare Champus-­‐Tricare Champus-­‐Tricare Champus-­‐Tricare Anthem
Top Rankings
Humana is the #1National Payer
Trends:
• Adoption of athena recommendations, as well as their ability to simplify claim processing, improve
accuracy, efficiency and clarity of all transactions supports top payer performance.
• Humana dedicates significant effort into managing PayerView performance throughout the year.
• United fell another two ranks after losing ground last year. Subsidiary performance continues to erode
overall performance, with some United affiliates submitting incomplete, inaccurate transactions.
• Anthem, previously known as Wellpoint, dropped to the bottom of the Top 10 after slipping for three years.
Confidential
*National payer performance reflects parent payer performance inclusive of it subsidiaries

13. Key Findings
Metric
PayerView
2014
PayerView
2015
DIFF
%
CHG
Days
in
A/R
30.131
31.134
1.0026
+3%
First
Pass
Resolve
Rate
0.934
0.938
0.0039
0%
Denial
Rate
0.084
0.085
0.0007
+1%
ERA
Transparency
0.937
0.946
0.0090
+1%
Provider
Collec4on
Burden
0.141
0.141
0.0001
0%
Eligibility
Accuracy
0.951
0.959
0.0077
1%
Benefit
Reliability
0.784
0.821
0.0363
5%
Enrollment
Efficiency
0.726
0.735
0.0096
1%
Enrollment
Turn
Around
Time
27.500
26.985
-­‐0.5150
-­‐2%
Metric changes YoY
PayerView Metric Change YoY
In 2015, athena observed metric stability and marginal improvement YoY with administrative
simplification. The magnitude of change is small but the direction is mostly positive, as seen in
previous years.
Trends:
• Metrics with greatest change include DAR and denial rate. Changes are a symptom of a constellation of
provider-payer pain points with outstanding automation needs such as Portal Workflows, Credentialing,
and Pre-Auth, Pre-Cert, and Referral requirements.
• The greatest improvement in Benefit Reliability was seen most in high ranking Blues.
• Enrollment TAT improvement of .5days is a reflect payers continued efforts to speed provider enrollment by
existing methods: portal, email, and faxed forms.

14. Market Turbulence in 2014
In 2015, we avoided large, disruptive regulation such as the implementation of ICD-10 and the Health Plan
Identification policy. New, high-volume, high-performing commercial payers included in 2015 PayerView
helped raise the tide for the network and improved overall performance.
Improvement in Denial Rate
despite Medicare PECOS
policy changes and
Medicaid Expansion.
Improvement in ERA
Transparency from the
implementation of CAQH
Core Operating Rules.
Improvement in Eligibility
Accuracy despite the
problematic roll-out of
Healthcare.gov.
Key Findings
Payer
Improvement in Benefit
Reliability in spite of new
health plans in the market.
PayerView Observations
Market turbulence in 2014 presented unknown risks to performance. But, payers sustained metric
performance through change.
PCB did not increase
despite the increase of
high-deductible plans into
the market.
MU, PQRS, VBM, CCM, and PBB
added complexity to the standard
claim submission process but did not
slow DAR.

15. Health reform did not impact payer
performance as anticipated
In 2013 and 2014 Medicaid Expansion states
perform better than Non-Expansion states.
Compared to last year, Expansion states
improved PCB, Eligibility, Benefit Reliability, FPR,
and ERA Transparency MORE than Non-
Expansion States improved despite enrollment
increases. Expansion states improved most in
overall score and Benefit Reliability.
In 2013 and 2014 Blues and Commercial
payers offering health plans in the exchanges
performed better than non-HIX carriers. Non-
HIX payers must focus on Benefit Reliability to
avoid slipping further behind. HIX payers need
to improve DAR and Eligibility Accuracy to
stay ahead of the non-HIX payers.
Non-HIX HIX
DAR 29.94 days 26.78 days
PCB 14% 16%
Denial Rate 7% 6%
Benefit
Reliability
78% 87%
Eligibility
Accuracy
97% 97%
Key Findings
0.0 0.5 1.0 1.5 2.0 2.5 3.0
Expanding
Not Expanding
Expanding
Not Expanding
20132014
Average of BENEFITRELIABILITY
Average of OVERALLSCORE 2014
Note:
Overall
Score
improvement
is
represented
by
a
decrease
in
value.
Benefit
Reliability
improvement
is
an
increase
in
value.
Confidential
Impact of ACA on PayerView

16. Opportunities for performance enhancement
in PayerView next year
High ImpactLow Impact
Administrative Portal Access:
Ease web-based workflows by granting
administrative access to vendors that offer web-
based services like credentialing, enrollment,
authorization, re-work and resubmission.
Eligibility Enhancements:
Return additional values
essential to managing
members under risk such as HIX,
care gaps, determination, and
CPT level pre-authorization.
ERA/EFT Enrollment:
Monitor enrollment by TAX ID to ensure
EFT/ERA goals are met. Allow for
custom enrollment configurations for
complex health systems
(278) Pre-Auth/Pre-Cert:
Implement the HSR
transaction to reduce
calls, denials, and
manual work for referral,
pre-auth and pre-cert.
LowEffort
Key Findings
(275) Claim Attachment
Implement the 275 to
reduce DAR and Denial
Rates related to claims
aging or otherwise held
for attachments.
(CCD) Coordinator for Health Plans.
Streamline clinical data exchange by
adopting the industry standard
transactions like CCD. Manage new
payment and delivery models and
avoid denials, audits, and claim re-work
MoreEffort
Confidential
PayerView Recommendations
Areas of alignment with athenahealth Inc. for PayerView Improvement
Call Reduction:
Reduce calls for claims aging,
and claims held for payment,
incomplete provider and remit
information by working with
providers and vendors directly.

17. 15

18. 2015 National Payor Survey
MAY 2015
Prepared by:

19. Research Methods
• 201 responses were collected from hospital & health
system leaders between February 9 to March 20, 2015.
• 157 responses were collected from online survey and 44
responses were collected via phone interview.
• The margin of error for the sample is +/-6.8% at 95%
confidence level.
• All participants were given the option to enter in a
drawing to win one of two (2) Apple Watches.

20. Sample
Of the 201 respondents:
• 1 in 4 were Vice Presidents of Managed Care (or an
equivalent).
• Over 1 in 3 (37%) were Directors of Managed Care (or
an equivalent).
• More than 1 in 5 were CEOs, CFOs, COOs, or other
administrators.
• Among those choosing “other” as their response, an
additional 3% indicated a title involving managed
care.
The average number of hospitals overseen
by respondents was 17.
Percent Respondents by
Role or Function
16%
14%
8%
37%
25%
VP Managed Care
Director Managed Care
CEO, COO, Administrator
CFO
Other (Please specify)
Q. Which of the following best describes your current role/function in your hospital / health system?

21. Commercial Payors Under Contract
90% of respondents reported having contracts with Aetna and
UnitedHealthcare, with 90% reporting Cigna and 88% reporting BCBS.
Q. Which of the following commercial payor does your organization have contracts?
*Blue Cross / Blue Shield was defined as “The Blue Cross / Blue Shield plan in your state or the one you do business with most often.”
Proportion of Respondents Indicating Contract
Aetna
UnitedHealthcare
Cigna
Blue Cross / Blue Shield*
Humana
Coventry
Wellpoint / Anthem
Other (Please specify) 39%
49%
77%
80%
88%
90%
90%
90%

22. Trust toward Payors (Reliability)
• The average of all
payor scores is
54.2. The average
change from 2014
is -2.1.
• Humana (+0.8) and
UnitedHealthcare
(+1.1) were the only
payors to increase
in this trust
measure over
2014’s scores.
Q. For each health plan below, indicate your level of agreement with this statement: This organization makes every effort to honor its commitments.
*Trust Index score values are calculated on a scale from 0 for “Strongly Disagree” to 100 for “Strongly Agree” when “Neither” is valued at 50 and
“Don’t Know” responses are excluded from the analysis.
Trust Index Score (Reliability) by Payor*
Cigna
Blue Cross/Blue Shield
Aetna
Humana
Bluecard
Wellpoint/Anthem
UnitedHealthcare
44.2
47.3
49.1
54.1
55.9
63.9
65.1
43.1
55.3
49.2
53.3
60.9
65.9
66.4
2014 2015
This organization makes every effort to honor its commitments.
-1.3
-2
-5
0.8
-0.1
-8
1.1
Year-Over-Year
Change

23. Trust toward Payors (Honesty)
• The average of all
payor scores is 54.2.
The average decrease
from 2014 ratings is
-0.9.
• UnitedHealthcare
again performed
worst with a score of
42.6 – 11.5 points
below average.
• Humana was the only
payor on this scale to
have experienced an
increase from 2014 –
by nearly two points.
Q. For each health plan below, indicate your level of agreement with this statement: This organization is accurate and honest in representing
itself and its intentions.
*Trust Index score values are calculated on a scale from 0 for “Strongly Disagree” to 100 for “Strongly Agree” when “Neither” is valued at 50
and “Don’t Know” responses are excluded from the analysis.
Trust Index Score by Payor*
Cigna
Blue Cross/Blue Shield
Aetna
Humana
Wellpoint/Anthem
Bluecard
UnitedHealthcare
42.6
49.5
51
53.9
56.5
61.8
64.1
42.7
51.2
52.5
52
59.5
62
65.9
2014 2015
This organization is accurate and honest in representing itself and its intentions.
Year-Over-Year
Change
-1.8
-0.2
-3
1.9
-1.5
-1.7
-0.1

24. Trust toward Payors (Fairness)
• The average of all
payor scores is 47.1;
all scores were lower
in this measure,
suggesting a
continuing
disconnect between
interest of payors and
providers.
• Scores in this category
are the lowest of the
trust measures, yet
most scores increased
compared to 2014.
Q. For each health plan below, indicate your level of agreement with this statement: This organization balances its interests with ours and doesn’t
routinely take advantage of us.
*Trust Index score values are calculated on a scale from 0 for “Strongly Disagree” to 100 for “Strongly Agree” when “Neither” is valued at 50
and “Don’t Know” responses are excluded from the analysis.
Trust Index Score by Payor*
Cigna
Aetna
Blue Cross/Blue Shield
Humana
Bluecard
Wellpoint/Anthem
UnitedHealthcare
34.7
42.4
44.6
45.8
51.2
51.9
58.9
36.4
44.2
41.5
45.1
48.7
51.5
57
2014 2015
This organization balances its interests with ours and doesn’t routinely
take advantage of us.
1.9
0.4
2.5
0.7
3.1
-1.6
-1.7
Year-Over-Year
Change

25. Trust Toward Payors – Combined
• The average score
for all payors was
51.8
• BCBS, Humana, and
Bluecard improved
on their scores from
2014; Cigna, Aetna,
Anthem, and United
all declined in trust
from 2014.
*Composite Trust Index Score values are calculated as an equally-weighted mean of all three individual Trust measures.
*Trust Index score values are calculated on a scale from 0 for “Strongly Disagree” to 100 for “Strongly Agree” when “Neither” is valued at 50
and “Don’t Know” responses are excluded from the analysis.
Composite Trust Index Score by Payor*
Cigna
Blue Cross / Blue Shield
Aetna
Humana
Bluecard
Wellpoint / Anthem
UnitedHealthcare
40.5
46.9
47.7
51.3
54.8
59
62.7
40.7
50.7
47.3
50.1
56.5
58.9
63.1
2014 2015
Composite Trust Measures*
-0.4
0.1
-1.7
1.2
0.4
-3.2
-0.2
Year-Over-Year
Change

26. Relationship Factors
Q. Thinking about the relationship your organization has with commercial payors, how important are each of the following factors to you?
Please use 100 points and distribute it across the six factors to indicate relative importance of each factor.
Relative Importance of
Factors in Payor
Relationships
Region 1
0 7.5 15 22.5 30
14.1
17.8
18.2
20.6
29.3
Payment rates
Negotiating new rates/contracts in good faith
Minimizing hassles/delays associated with claim payment
Getting paid "on time" per contract terms
Responding fairly to requests for authorization/eligibility

27. Volume to Value
Overwhelmingly, hospital
and health system leaders
expect the majority of
their 2015 revenues (more
than 4/5) to come from
volume-based payments
(e.g., traditional fee for
service) versus from
value-based payments.
Q. Over the course of calendar year 2015, what percent of your total revenues (from all payor sources including commercial insurance, Medicare,
Medicaid, TriCare, etc.) will be based on VOLUME (e.g., traditional fee for services) versus VALUE (payments at risk based on measurable quality
and/or outcomes)?
Projected Revenue from
Volume versus Value
Volume
82%
Value
18%

28. Volume-to-Value Initiatives
• Pay-for-quality programs sponsored by insurance companies were the initiatives most likely
to be pursued in 2015.
• In “Other”, 4% of respondents mentioned “bundled payments” and 3% mentioned “clinically
integrated networks” or improved physician engagement.
Q. Which of the following strategies/initiatives is your organization pursuing or likely to pursue in 2015 to help make the shift from Volume
to Value?
Percentage of Volume-to-Value Initiatives Underway
Insurance-sponsored pay-for-quality programs
ACO or other risk sharing arrangement
Government-sponsored pay-for-quality programs
Taking on risk for payment of claims for employees
Medical home models
Other
Don't know at this point 6.5%
19.9%
50.2%
54.2%
63.7%
65.2%
77.1%

29. Biggest Risk for Providers
“Biggest concern is healthcare reform and CMS. Their changes are driving entire market right
now. Government is biggest unknown and risk.”
“The biggest thing is going to be dealing with the decreased funding that will be available to
healthcare facilities in the next 2-3 years.”
“How fast do we evolve our contracting and population health initiatives to move from volume
to value, given the broad spectrum of payers (governmental and commercial) that are now
working in this arena?”
Q. Before we wrap up, looking more broadly at your organization, what do you think is the single biggest risk you face as you look out on a two- or
three-year horizon? Your response doesn’t have to be about payors, it can be about any concern or worry you may have.
“
“
“
Government-based
uncertainty: State
funding, ACA, Legislative/
Regulatory Changes
Transition from
Volume to Value
Payment
Challenges:
Declining rates
Narrow
Networks &
their impact
19% 19% 14% 10%

30. Brandon Edwards
CEO
ReviveHealth
thinkrevivehealth.com
Dan Prince
President
Catalyst Healthcare Research
catalysthcr.com
Laurie Graham
Payer Operations Manager
athenahealth
athenahealth.com
Question & Answers