Brandon Edwards, CEO of ReviveHealth, and Eric Dahlberg, manager of payer and healthcare outreach for athenahealth, discussed the unique role trust plays in payer-provider business relationships at Becker’s Hospital Review 7th Annual Meeting in Chicago April 29.
Traditionally, insurance companies have been built around the ability to manage risk, administer cost-sharing and pay claims. However, the line between payers and providers is starting to blur as healthcare organizations plan for the shift from volume to value-based care, said Mr. Dahlberg. Some payers have begun to diversify their assets by acquiring provider organizations and buying stakes in health systems. Many provider organizations are getting into the insurance game by launching health plans of their own.
Payers and providers are grappling with other industry changes as well, including the dramatic shift in regional and national payer makeup, significant consolidation in payer and provider spaces, increased patient financial obligation, explosive technology innovation and a surge in alternative sites of care.
As a result, payers and providers are equally anxious about what they can do to stay relevant moving forward. In extremely complicated, heavily regulated business-to-business environments, companies rely on peer trust for support and partnership, said Mr. Edwards. Yet a survey by ReviveHealth found healthcare is the second lowest rated industry for trust by B2B audiences.
To measure trust levels, ReviveHealth asked hospital system leaders to rate payers they contract with on a scale of 1-100 according to each of the following three questions:
- Does the payer make every effort to fulfill promised commitments?
- Is the payer accurate and honest in representing itself and its intentions?
- Does the payer balance its interests with the providers, and not routinely take advantage them?
Overall, the survey results were not promising. Cigna had an overall trust rating of 62.7 out of 100, Blue Cross Blue Shield had an overall rating of 59, Humana rated at 51.3, Anthem rated at 46.9 and UnitedHealthcare rated a 40.5. “On an academic grade scale, these are not even close to passing grades,” said Mr. Edwards.
Interestingly, Revivehealth found reimbursement levels had little correlation to provider trust scores. UnitedHealthcare routinely ranked amongst the top payers for reimbursement rates, but the insurer finished last in provider trust for the past 10 consecutive years, according to Mr. Edwards.
ReviveHealth found health plan employees don’t even trust their payer peers and colleagues. About 57 percent of insurance employees surveyed said they believe their competitors have engaged in unethical business behaviors, according ReviveHealth’s latest Payor Trust Index.
When business parties do not trust one another, they cannot build and engage in collaborative partnerships that successfully manage risk, something that is integral to surviving in a value-based world. Armed with this knowledge, how can the industry rectify its trust issues? Mr. Dalhberg believes transparency is the key to improving payer-provider relationships.
athenahealth’s PayorView report is one way the company is working to leverage payer performance data to help providers evaluate risk-based partners. In PayorView, athenahealth aggregates key metrics of payer performance that affect business relationships, such as days accounts are in accounts receivable, first pass resolution rates and the amount of time it takes payers to adjudicate claims and deliver payment.
Mr. Edwards and Mr. Dahlberg believe increased information sharing will inspire better performing business partnerships. Payers and providers can effectively tackle today’s healthcare challenges by working together to jointly develop new care delivery models that serve the best interests of both business partners.
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