Wilting Payer-Provider Relationships

Physicians feel at a distinct disadvantage when it comes to working with payers.

Where has all the trust gone? ReviveHealth, a healthcare communications company, has conducted its National Payor Survey for the past nine years. The survey is unique in that it examines the opinions of hospital and healthcare system leadership, a group often overlooked when speaking about payer relations. Brandon Edwards, CEO of ReviveHealth, says the impetus for initiating the survey was the lack of data on provider opinion. "There was nowhere you could find how providers felt about the clients they partnered with."

Edwards says that the ReviveHealth survey looks at three factors that are intrinsic to building trust between business partners: fairness, honesty, and follow-through. While Cigna, Blue Cross Blue Shield, and Aetna all scored above average this year on the composite trust score, no one received better than 63 (on a scale of 0 to 100), which Edwards points out is an F. When it comes to flagging trust between payers and providers, he says, "I'll tell you what we know, and then I'll tell you what we think. To say that trust is poor between health systems and payers would be a vast understatement. … I think that the healthcare system and provider organization executives believe that the game is rigged, if you will, for the payer. Meaning that there is an imbalance of power in the system that makes it very difficult for [physicians] to deal with insurance companies on a level playing field," he says.

Marshall Baker, president and CEO at Boise, Idaho-based Physician Advisory Services, has been in the healthcare industry for close to three decades, and in that time has seen a sea change in provider relationships. "I've had the opportunity to participate with a number of different environments and drivers, and changes obviously from the good-old days where the payer just paid charges. You sent your bill in and when the payer adjudicated it you got pretty much what you charged," he says. Now, in large part due to economic pressures, Baker says, "The payer-physician relationship has probably … lost the emphasis that it had in other times, because the payers have cost concerns too. Can they afford to have a staff of provider-relations people out on the road, knocking on the door?" And if they could, Baker says physicians are usually too busy to take time out of a bursting patient schedule to speak with any provider rep, whether they are representing the pharmaceutical industry or payers.