Vitality Payer Scorecard

True payer transparency backed by data directly from hospitals, for hospitals.

Hospitals have moved from heroes to zeros in the public eye.

Healthcare providers are facing an increasingly challenging reimbursement environment and unprecedented cost containment pressures due to healthcare payer performance.

The narrative? Hospitals and healthcare systems are the cause of affordability issues.

The reality? Most major healthcare insurers are running billions behind in payments to hospitals and physicians.

The result? Reimbursement denials are coverage denials. Administrative delays are patient care delays. Administrative costs are ultimately patient costs.

Hospitals lack critical data to help address the challenges caused by commercial payer issues.

There are no unbiased industry standards or measurements that can help our members analyze the operational and financial efficiency of their hospital compared to the rest of the field. State hospital association attempts to collect data from area hospitals to set “benchmarks” resulted in a time consuming, monthly, manual entry spreadsheet exercise that is full of user errors or incomplete data.

What if you could see the whole picture to address commercial payer issues and help you better navigate this environment?

Every advocacy leader knows that you cannot just tell one story and make a great impact. You can see what is happening within your hospital/health system by payer, but it is not enough to bring these critical issues to the forefront of state and national legislative and regulatory oversight to make positive change. The more you know about how a payer operates in your state and throughout the nation, the better positioned you will be to hold them accountable.

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The solution is a national, de-identified, normalized database
of hospital claims and remittances.

You need to look to others to help expose the negative patterns in payer behavior. Showing that you are not alone amplifies your organization’s voice.

We make it easy with the Vitality Payer Scorecard

We know that data aggregation is a requirement for accurately measuring payer practices and improving provider negotiations. The AHA Vitality Index/Payer Scorecard brings everyone together with necessary and normalized data points, without sharing PHI, charges, or any other information that has been a roadblock to this kind of collaboration in the past.

Real, Aggregated and Automated Payer Performance Data

Using benchmark comparisons, accounts receivable and prompt payment information by payer can help health systems assess the root causes of claims payment delays. Comparing denials details across payers, payer types, and lines of business help health systems evaluate billing and medical record documentation issues, while highlighting egregious payer denial practices.

Powerful, Quantitative Evidence

The Vitality Payer Scorecard supplies hospitals and hospital state associations with powerful, quantitative evidence to support provider work against anticompetitive practices. At your fingertips at all times. You will see who is thriving, who needs help, and spotlight which payers are good or bad actors to aid in state policy/advocacy issues.

Standardized Values

All metrics are normalized so you can filter by patient type (IP/OP), specialty (OB, Ortho, etc.), and payer. The Vitality Payer Scorecard shows specifics to your organization just for your users and de-identifies your healthcare peers, rolling up to state and national views, creating reliable and valid data in which to draw evidence-based conclusions for the purposes of advocacy at the state and federal level.

Meaningful Measurement

Operational metrics, focused on revenue flow for your hospital, and for your state, regional and national deidentifed hospital peers:

Prompt Pay

Measure how slow payers are paying you

Reimbursement

Compare reimbursement and analyze lesser rate of charge

Denials

Gain visibility to detailed denial metrics

The Vitality Payer Scorecard is an ecosystem of actionable data and metrics to support American Hospital Association member constituencies to include state hospital associations, health systems and hospitals.

With the Vitality Payer Scorecard, you will answer questions that were once unanswerable.

What hospitals have claim processing challenges and which are efficient?
What payers have prompt payment timing issues?
What hospitals have denial issues where others do not?
What payers have denial issues across specific states (national and state payers)?
How much are managed care reimbursements across states and from what providers (percentiles not dollars)?

Hospitals helping hospitals.
Coming together for the collective good of healthcare.