Opinion: Payers, you are the weakest link

In the patient-payer-provider triad, payers are not fully capitalizing on their relationships, according to Rena Xu, MD, a resident physician at Boston-based Massachusetts General Hospital and contributor to The New Yorker.

In The New Yorker, Dr. Xu wrote patients and payers remain more closely aligned, while payers lack effective relationships with both groups. For example, she cited a study from the Journal of Heath Economics that showed just one in seven Americans understand the basics of health insurance plans. Another survey she cited from Harris Poll showed health insurance as an industry is only consistently trusted more than the oil and tobacco industries.

Part of the barrier between patients and payers is a major lack of understanding, according to Dr. Xu. Insurance websites and benefits descriptions can be difficult to understand and navigate, while customer service is often impenetrable.

Payers and providers also have issues seeing eye-to-eye. Providers are traditionally not focused on the cost of care, Dr. Xu wrote, and in the fee-for-service model that still dominates healthcare, provider incentives are not aligned to change this focus. On top of that, providers struggle to deal with insurers, wasting time and revenue, she wrote.

Health insurance is absolutely critical to healthcare reform, according to Dr. Xu. "Fundamentally, though, it comes down to redefining the dynamics of the patient-insurer-provider triad: building a stronger relationship between patients and insurers, and turning the reimbursement tug-of-war between insurers and providers into a partnership," she wrote in The New Yorker.

Read the full essay here.


More articles on payer issues:

ACA health plans limit access to specialists: 7 findings
Lawsuit settlement forces Anthem Blue Cross to refund $8.3 million to Calif. consumers
Utah shuts down nonprofit insurance co-op

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