Through my research into the Healthcare Payer market, it is apparent that there is a significant trust issue between Payers and Providers. In a market where we're seeing an ever increasing percentage of convergence between the two parties, this mistrust serves as an unwelcome roadblock to innovation and unfortunately the patients are likely to be the ones who suffer.
As we've seen in the recently published PayerView report by Athenahealth and ReviveHealth, although overall benefit reliability is improving, there is still a lot of work to do in regards to streamlining workflows, making processes more efficient and ultimately bridging the trust gap.
In this blog, I'm going to lay out a few recommendations for both Payers and Providers on how to build trust with the other party based on what I've come across during my research. Many of these points apply to both entities but for the purposes of this blog post, we'll look at them separately:
Payers
- Remain agile: As can be seen in the PayerView rankings, the top two performers are small, commercial players. Although there's a general assumption that smaller organisations are more agile, regardless of the size, Payers must be able to quickly react to market shifts including regulatory changes.
- Integrate and coordinate your data: Easier said than done but integrating and coordinating your data will have many benefits as it will streamline workflows, simplify claims processing and make transactions more accurate and efficient. Also, once your data is aggregated, this then enables you to analyze it for future improvements.
- Communicate: Communication is vital with both patients and Providers. Technologies such as portals, patient accessible EHRs, mobile access and secure messaging will engage patients while clinical information sharing, timely pre-authorizations and a reduction of unnecessary procedures will bridge the gap with Providers.
- Learn from Payers: Payers are well versed in areas such as patient engagement despite Providers having more direct contact. With the rise of technologies like telehealth, remote monitoring, mobile access etc, Providers should look at what Payers are doing to retain and engage patients and if appropriate, learn from them.
- Invest in HIT: Payers are more likely to contract with Providers who deploy software and systems supporting clinical integration and Population Health Management. The associated analytical efforts based on these would help Payers in calculating more accurate insurance premiums as well as having many patient health benefits.
- Discuss financial risk bearing: As the market embraces a value-based reimbursement model, one of the primary reasons Payers do not trust Providers is the unwillingness to accept financial risk. Once again, this is not an easy fix but clear and transparent communication on mutual goals will certainly help this process.
Best Regards,
Jonathan Cordwell
Research Analyst, Healthcare Strategy
ResearchNetwork, CSC
- Athenahealth, PayerView 2015, http://www.athenahealth.com/network-data-insights/payerview
- Managed Healthcare Executive, Best practices for payers and providers to cooperate in the era of convergence, http://managedhealthcareexecutive.modernmedicine.com/managed-healthcare-executive/news/best-practices-payers-and-providers-cooperate-era-convergence, 23 Dec 2014
- HealthcareIT News, Engaging patients: 5 things providers can learn from payers, http://www.healthcareitnews.com/blog/engaging-patients-5-things-providers-can-learn-payers, 8 Sep 2014
- FTI Consulting, Gap Separates Payers and Physicians on Value-Based Arrangements, According to a New Study Released by FTI Consulting, http://www.fticonsulting.co.uk/global2/press-releases/united-states/gap-separates-payers-and-physicians-by-fti-consulting.aspx, 30 Jul 2014
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