The unhealthy payer-provider marriage


Trust is what makes all good relationships work. Whether with spouses, families, friends or business partners, trust is the cornerstone of a strong, healthy bond.

Newly engaged, I've found wedding planning has been a good lesson in trust, compromise and honesty (as well as the need to do more with less). All of which are issues facing our healthcare system, especially as payers transition away from just writing checks to partnering in care delivery to improve outcomes and lower costs.

The industry shift to coordinated, accountable care has been driving the marriage of payers and providers. But based on recent survey findings, it's not looking like wedded bliss. One illustration: FierceHealthPayer last week reported on a ReviveHealth survey of hospital leaders who expressed little trust in their health insurance companies.

Much of that distrust stems from contractual "gotchas," in which a health plan doesn't do what the contract says or exhibits unexpected behavior changes, Clint Hailey, chief managed care officer at Dallas-based Tenet Healthcare, told FierceHealthPayer in an email. Hailey said such gotchas happen far too often, but he's hopeful about open and honest relationships between payers and providers.

"Despite the survey's mostly negative results, at Tenet, we work with some honest, reliable health plans that are making significant contributions to collaborative, industry-changing initiatives, and we would like to see more of the health plans participate with us to greatly expand system improvements," Hailey said.

Most payer and provider interactions involve rate negotiations; instead of playing gotcha, payers need to promote honesty.

Doug Chaet, senior vice president of contracting and provider networks at Philadelphia-based Independence Blue Cross, spent 20 years representing hospitals. Having sat on both sides of the negotiation table, he found the right way to earn trust involves compromise.

"If I want $10 and they want $20, we settle on $15," Chaet said. Both parties may not be completely satisfied, he said, but if both the payer and provider were honest throughout process and clear about expectations, then it's a good outcome.

As I'm learning during the wedding planning process, my soon-to-be spouse and I are a team now and we have to work through decisions and problems together--with compromise and cooperation. In healthcare, as in marriage, that's often easier said than done, but necessary to create mutually beneficial partnerships that improve population health and patient experience and lower costs.

Perhaps with a little marriage counseling, payers can learn how to foster the type of collaboration Hailey wants more of at Tenet. As part of healthcare marriage counseling, the first step should be to align incentives so each organization has the motivation to improve outcomes and lower costs.

"If we share the same financial incentives, it becomes in both parties' business and economic interests to collaborate. If both sides benefit from the same outcome or result, there's no reason to be at odds," Debbie Gordon, vice president of marketing, sales and product strategy for senior products at Massachusetts-based Tufts Health Plan, told FierceHealthPayer.

With payment and delivery reforms better aligning incentives across the care continuum and showing collaborative care can lead to high-quality, low-cost care, it's time to make those marriages last. How does your organization work toward better payer-provider relations? What are some ways to build trust? - Alicia (@HealthPayer)

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