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Athena Health recently published the 2016 edition of Payer View, a in-depth review of the biggest payers in their network. Athena Health identifies the shift to value based care and healthcare reform as the biggest challenges to everyone for payers to providers. Let’s discuss how this new study reviews payer performance.

Athena Health’s Payer View Data Shows

  • That 2016 saw a big shift in the payers who traditionally been at the top of the charts
  • 29% AthenaHealth payers actually met the criteria for inclusion in PayerView than 2015
  • “Several Blues and Medicare Part B payers had outstanding performance this year – making for an impressively diverse Top 10 overall”

Why Payer Performance Matters in Healthcare

In the complex world of healthcare, payer performance is critical. It directly impacts the quality of care patients receive and the financial stability of healthcare organizations. This blog explores the pivotal role payers play in shaping the industry, from cost management to improving patient outcomes, and why it’s a top priority.

Payer Performance: High Performers


  • National commercial payers where cited has having the most Powerful Administrative Performance with a 90.9% score on the Enrollment Efficiency metric.
  • Blues show a continuing trend of outstanding excellence. 25.9 was the average in account receivable for Blues payers.
  • Medicare Part B Payers are considered leaders in claim resolution. Scoring 96.9% on the First Pass Resolve Metric.

Athena Health also discusses important ways providers, payers and stakeholders can collaborate.

  • Embrace new technology and new tools
  • Simplify “Patient eligibility and obligation determination
  • Look at automation in a new light, to achieve efficiencies and improve care delivery
  • Prior authorization and credentialing might be a subject worthy of collaboration

Read the full Athena Health report here.