AHA Vitality Index

Earlier this week I emailed the membership about the growing challenges with payors.  Many of you responded that your organizations are reporting significant increases in commercial payer issues, including payment delays, underpayments, payer audits, denials of care, and hurdles to resolving issues with commercial payers.

In fact, not only hospitals, but our nursing home members have expressed challenges with Medicare Advantage (MA) and other out-of-state plans.  For one of our hospitals, the rate of growth for MA plans has gone from zero-covered lives to more than 30% in three short years.

Last week, JAMA published a report that has led many to believe that “the profitability in MA might be partially due to coverage denials harmful to patient care,” according to medical economist Paul Keckley.

MHA is meeting with the State Auditor and Insurance Commissioner to raise awareness of the issues providers are facing with a number of health plans.  However, in order to address the problem—whether through monitoring health plan performance, elevating issues to the regulatory agencies, or pursuing state and federal legislative solutions—we need data.

I urge your organization to consider joining the effort to hold commercial payers accountable through the AHA Vitality Index. The AHA Vitality Index is an operational metrics dashboard designed to measure revenue flow and yield key insights into how your organization’s denial and payment rates compare to your peers. This solution can help hospitals uncover how often their organization’s payment claims are denied, determine if those denial rates vary by payer or service line, and compare their organization’s metrics to other providers and peer groups.

The AHA Vitality Index automates data transfer and creates a national, de-identified, normalized database of hospital claims and remittances. Not until now have we had the ability to deploy an “all payor claims database” that gives us the ability to track and measure health plan behavior across our state and the nation.

MHA has partnered with the AHA to bring this effective tool to Montana hospitals. As our state continues to mature in its payor marketplace, the challenge with plans will only grow.  Timely data is our most effective tool, and the Vitality Index gives us the data we are missing in our advocacy.

There are several upcoming opportunities to learn more, including upcoming Region Meetings and a special webinar for the membership scheduled this fall. I also encourage you to use the link below to learn more about the AHA Vitality Index.

MHA serves as a critical advocate for our patients and ensuring their care is covered is central to our role.  The Vitality Index is an effective tool that will help us track payor behavior and use the information to improve health and healthcare in Montana



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