Tension between providers and payers persists, hampering care
One clinician's suggestion for improving the payers-provider relationship: “Marriage counseling such that they don’t view each other as the enemy.”
Collaboration between insurers and health care providers could stand to significantly improve.
That’s the takeaway from a survey of health care leaders conducted by New England Journal of Medicine-Catalyst. The study was led by Namita Seth Mohta, MD., clinical editor of NEJM Catalyst, and Leemore Duffy, PhD, of the at Harvard School of Business.
More than three-quarters (77 percent) of the 607 health care executives, clinical leaders and clinicians surveyed said that payers and providers are not aligned towards achieving increased value in care delivery. Respondents were eager to apply the same skepticism to themselves; 58 percent said their own organizations were not properly aligned with either payers or providers.
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Just over half of respondents believe that payers and providers are aligned on providing quality of care. However, on care coordination, cost of care and using data to make better decisions for patients, the great majority of respondents said that collaboration is unsatisfactory.
Respondents displayed support for organizations that integrated provider and insurance services, such as Kaiser Permanente. Two-thirds said that such organizations have made important progress towards “innovative, risk-based payment arrangements.”
However, the traditional tension between providers and payers persists, the study finds. Providers view themselves as looking out for patients and see insurers as singularly focused on cutting costs.
Health care leaders were almost evenly divided on which industry stakeholder has the greatest potential to bring about meaningful change in payment models. Asked to pick the top two most important stakeholders, 50 percent said payers, while 48 percent said providers, 39 percent said the government/regulators, 36 percent said employers and 21 percent said patients/customers.
However, when asked what are the main drivers of collaboration between payers and providers, a large majority (71 percent) cited regulatory payment model changes led by government programs, notably Medicare. A majority also cited improved data analytics (53 percent), and 61 percent think a single-payer system would help.
The report included a number of comments from respondents about how greater collaboration could come about. Suggested one clinician about payers and providers: “Marriage counseling such that they don’t view each other as the enemy.”
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