Top Healthcare Payors by Incurred Claims

A healthcare payor (or “payer”) is the organization or entity settling medical claims on behalf of patients. Payors are generally insurance companies, employee health plans, or other third-party payors. Definitive Healthcare currently tracks more than 1,340 payors and payor subsidiaries.

Like providers and the rest of the healthcare industry, payors are invested in reducing care costs as well a reducing instances of financial fraud, waste, and abuse. To lower overall healthcare costs, payors can leverage data from hospitals, outpatient surgery centers, and other care facilities. The issue many executives and healthcare leaders face is an overwhelming amount of data, with little ability to effectively draw actionable insights. Some of the most important hospital performance metrics include readmission rates, cost per discharge, and bad debt.

One method payors and providers are utilizing is an emphasis on value-based care. The Centers for Medicare and Medicaid Services (CMS) in particular have launched several programs that reimburse hospitals and care facilities based on patient outcome rather than on the services provided. This incentivizes providers to use more cost-effective care methods and encourages comprehensive, connected care as well as patient follow-up to reduce the chance of readmission.

In the list below, the average cost of incurred claims for each insured patient is $4,648. Additionally, while the total number of covered lives did slightly correlate with incurred claims, there are several outliers. The payor with the greatest number of covered lives, UnitedHealthCare, was only in second place for total incurred claims. Half a dozen other payors also followed this pattern, incurring less in claims costs despite covering a greater number of lives.

 Top 5 Payors by Incurred Claims (M)

  1. Kaiser Permanente: $37,471
  2. UnitedHealthCare: $34,784
  3. Anthem Blue Cross & Blue Shield: $34,515
  4. Health Care Service Corporation Group: $22,835
  5. Aetna: $20,325

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