Payer Mix Shift & Contract Performance Analytics

Summit Regional Medical Center — 310-bed Community Hospital

Payer Mix Index
0.87
-6.5% vs. YoY
Commercial Share
41.2%
-5.8pp vs. LY
NR per Adj. Discharge
$7,420
-3.2% MoM
Medicaid MCO Share
18.0%
+6.0pp vs. LY
Underpayment Recovery
67%
+4pp QoQ
Target: 75%
Contract Variance
-2.1%
Unfav vs. Budget
Budget: 0.0%

Payer Mix Composition — 52-Week Stacked Area

Commercial Share vs. PMI

Effective Reimbursement Rate by Payer

Anthem BCBS Tier Proximity

Volume: 14,053 / Target: 15,000
94%
47 days to tier renewal

UnitedHealthcare Tier

Volume: 9,240 / Target: 12,000
77%
Risk: tier drop in Q1

Aetna Commercial

Volume: 5,820 / Target: 5,000
116%
Tier secured

Contract Compliance & Underpayment Heatmap

Jan
Feb
Mar
Apr
May
Jun
Anthem BCBS
98%
97%
94%
99%
93%
96%
UnitedHealthcare
91%
88%
87%
90%
86%
92%
Aetna
96%
97%
98%
99%
97%
96%
Cigna
93%
91%
89%
92%
94%
93%
Humana
98%
97%
96%
99%
98%
97%
Green: ≥95% contract compliance | Yellow: 90-94% | Orange: <90%

Medicaid MCO vs. FFS Rate Gap

NR per Adj. Discharge by Service Line

Payer Contract Detail Table

Payer Name Contract Tier Volume YTD Tier Target % to Target Days to Renewal Avg Reimb Rate Underpayment % Recovery $
Anthem BCBS Tier 1 14,053 15,000 94% 47 53.2% 2.1% $84,200
UnitedHealthcare Tier 2 9,240 12,000 77% 82 48.7% 4.8% $62,100
Aetna Commercial Tier 1 5,820 5,000 116% 122 55.8% 1.4% $38,400
Cigna Tier 2 3,680 4,500 82% 210 51.3% 3.6% $21,800
Humana Tier 1 4,120 3,800 108% 156 52.6% 1.9% $29,600
Medicare Advantage Standard 6,840 44.2% 2.8% $41,300
Medicaid MCO State Contract 8,920 28.4% 6.2% $18,200
Medicaid FFS State Rate 4,460 24.1% 8.4% $8,900