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It's time for payers to build trust, partnerships with providers
Comments
As in many fantasies, like a mutually happy divorce, this is great conceptually. Both sides have to set ground rules and define these before even sitting at the table. These ground rules must guide the discussions and focus on Quality, Value and Improving Health- not just of the participants, but also the Community. And maybe have a third party (or two) there to remind them of the ground rules periodically.
This article is emblematic of the problem. You make us out to be petty argumentative children by your statments. In actuality, there is much more to it than your gross over-simplification. First of all, most insurance companies, eg. payers, have as their primary goal, to increase shareholder wealth (it's a business). The goal of most physicians (ne: providers) is to provide the best care for their patients. These goals are not likely to ever coincide in the real world. Put simply, providers are on the wrong side of the payer's balance sheet. We have such different incentives, that it is ridiculously petty to make the argument that we just don't want to play nice with each other. Put another way, you are asking providers to coddle up to the very groups that have arbitrarily and systematically bundled codes, and refused to pay legitimate claims to them for the last 15 years. This has been confirmed by numerous court cases, settlements, and fines by multiple state insurance commissions.
I know we have to find solutions. Shared data is helpful, but to not understand the real nature of this conflict, is to doom future efforts to find common ground. And yes, a single government payer would fix it, but that's not likely to be acceptable to most Americans, unlike their European and Canadian cohorts. And good luck finding a doctor if we do that here.