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Consumers, providers have trust issues with health insurers


In order to help reform the healthcare system, health insurers must define their relationship with both providers and patients, according to an article in the New Yorker.

Efforts to engage members have seen limited success, in part because with the advent of employer-based coverage, consumers traditionally lack loyalty to specific brands and feel detached--even distrustful--of their insurers, writes Rena Xu, a resident physician at Massachusetts General Hospital in Boston.

In addition, Xu writes, insurers' websites are challenging to navigate, customer service is often difficult to reach and explanations of benefits are far from easy to understand.

Many providers, too, struggle in their dealings with insurers, as they waste valuable money and time on inefficient claims processing, according to Xu. The poorly aligned incentives associated with fee-for-service payment models don't help, either.

In fact, the newly released ReviveHealth Payor Trust Index finds that physicians broadly distrust health insurers and believe they interfere with their ability to provide quality care. The 600 primary care and specialist physicians polled said the quality of coverage and number of claims denials are what most influences their opinion of health insurers. And as the announcement notes, the pending Aetna-Humana and Anthem-Cigna mergers may exacerbate the payer-provider animosity.

Insurers have the power to change this paradigm, according to Xu. To accomplish this, they must, among other things, create and implement incentives that reward healthy behaviors while working to avoid unnecessary costs.

However, insurers must be careful when choosing to align with providers, Rita Numerof, Ph.D., president of Numerof & Associates, writes in a recent commentary for FierceHealthPayer. Rather than offering initiatives to their entire range of providers, she writes, insurers should instead focus on those most able to effectively implement cost and quality improvement.

To learn more:
- read the New Yorker piece
- here's the poll results announcement

Related Articles:
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Three questions about a health insurance industry in flux
Providers continue to distrust insurers
How insurers can make transparency tools more consumer-friendly