Execs tell how to shift provider-payer relationships from wary to trustful

The tension that has long simmered between providers and payers across U.S. healthcare is ripe for the easing. And the present moment may offer the best opportunity in decades for all parties to build trust where suspicion has become the default position.  

A trio of executives from UnitedHealth, Anthem and Permanente stated as much, and outlined a plan to get there from here, in an opinion piece published Feb. 25 in JAMA Network Open.

The authors pointed to several developments as reasons for their hopefulness. These include the volume-to-value movement, the ascent of outcomes-based analytics drawing from Big Data, and provider self-policing efforts such as Choosing Wisely and Less is More.

But while the current healthcare environment offers new possibilities to build trust, it lacks mechanisms for readily turning good intentions into collective actions. For meaningful change to take hold, the authors suggested, stakeholders will have to give their buy-in on what will constitute progress toward greater trust—and why and how they should pursue it.

As markers of measurable success, the authors listed competence (“each side doing its core business better”), transparency (“no black holes, make processes more transparent using data, really listen to each other”) and motive (“understand the other party’s positive intent, limitations and challenges”).

Meanwhile, they asserted, the “why” is straightforward: “No one is happy with the past or current state. Many reports suggest high levels of physician burnout that adversely affect clinicians, may harm patients and could impair the healthcare system.”

On this point they underscored the quadruple aim—better care, lower costs, better patient experience and a healthy workforce—and suggested its full promise will remain out of reach if providers and payers fail to work more collaboratively.

For the “how” portion of their case, the authors gave several examples of ongoing efforts.

“Payers, medical groups and hospitals have partnered in joint business ventures that promote more efficient sites of service- or value-oriented care delivery models,” they wrote. “Payers are experimenting with reducing administrative requirements, such as prior authorizations, particularly for partners who engage in value-based payment arrangements.”

The authors concluded their argument by urging healthcare leaders to shift their thinking on provider-payer relationships. Where historically these relationships have been based on contracts, they now must be built on “a shared covenant to patients and to system improvement.”

The next decade “could be transformational, or it could be a missed opportunity,” the executives wrote. “It is the responsibility of each person and organization in the U.S. healthcare system to make transformation real—in care delivery, in payment and, most powerfully, in relationships.”