The COVID-19 pandemic has exposed commercial health insurance plan practices that are impacting patient access and choices for care and driving excessive administrative costs and burden in the health care system. These practices — including use of prior authorization, denials of unanticipated but medically necessary care (like emergency services and early sepsis interventions), and anticompetitive conduct — are adversely affecting patients and providers.

A recent AHA survey of hospitals and health systems found that 89% of respondents experienced an increase in payment denials over the past three years, and 51% reported experiencing a “significant” increase in denials.

AHA Vitality Index™, a new solution from the AHA in collaboration with ATEX Financial, can help your team uncover how often your organization’s payment claims are denied, determine if those denial rates vary by payer or service line, and compare your organization’s metrics to other providers and peer groups.

The AHA Vitality Index benchmarking solution gives you access to aggregated, de-identified hospital data, so your team can analyze the operational and financial efficiency of your hospital compared to the rest of the field.

Objective Data for Better Decision-Making

Hospitals and health systems need greater visibility into commercial payer behavior, and data already is being generated by the electronic billing and remittance process. AHA Vitality Index provides that visibility with standardized metrics on denials, reimbursement and claims processing — helping AHA members identify and focus their improvement opportunities and strategies.

AHA Vitality Index is divided into four quadrants:

  • Velocity — measures the speed related to claims, remits and cash.
  • Volatility — looks at the risk that could impact the speed and amount of cash.
  • Variety — reviews what type of reimbursement is expected.
  • Value — evaluates the amount of reimbursement by payer, patient type and denial.

I encourage AHA members to learn more about this valuable analytic solution as a low-cost, high-impact resource for identifying opportunities for improved revenue capture process.

An added advantage of adopting this solution is it will provide access to actual data from the field and support AHA’s efforts to ensure fair coverage for patients and providers and address commercial health plan abuses.

A Special Offer for AHA Members

The AHA data team is committed to providing operational data that AHA member organizations can trust, and we offer a variety of other solutions to help your health care organization succeed in today’s rapidly evolving environment.

AHA members can request a demo of AHA Vitality Index and explore its features.

To learn more about the benefits and value of AHA membership, visit the AHA Member Center.

Gloria Kupferman is chief data strategy officer at the American Hospital Association.

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