Payer-provider tensions driven by ACA, other factors

By Aine Cryts

Physicians just don't trust payers. UnitedHealthcare and Cigna fared worst in the recently released ReviveHealth Payor Trust Index, whereas physicians viewed independent Blue Cross Blue Shield plans more kindly.

Payers damaged their relationships with physicians through their inability to deliver on their commitments, misrepresenting their companies and their intentions and by "routinely taking advantage of physicians," according to the survey, which was conducted with more than 600 primary care and specialty physicians around the country. Inefficient claims processing also hurt the perception of payers among physicians.

The Affordable Care Act and impending insurance company mergers have and will continue to impact how physicians and payers relate to each other, said Nathan S. Kaufman, managing director of Kaufman Strategic Advisors and a ReviveHealth Sounding Board member, in an announcement.

"Market power continues to be the primary driver of how healthcare dollars are distributed," he said. "If physicians think health plans are difficult to deal with now, just imagine negotiating with a company comprised of two of the largest, least-trusted ones, which is what we're looking at right now with the planned mergers involving Humana, Anthem and others."

Additional findings from the survey:

  • Blue Cross Blue Shield plans got high marks for enabling delivery of high-quality care (46 percent).
  • UnitedHealthcare was most often mentioned as the worst at helping physicians deliver high-quality care (26 percent). Humana (16 percent) didn't fare too well in physicians' eyes either, nor did Aetna (15 percent) or Anthem/Wellpoint (14 percent).
  • Five of the six top criteria chosen by physicians in rating an insurance company were relationship-driven.

Specific ways payers can build better relationships with providers include processing claims more efficiently and aligning incentives in fee-for-service contracts, FierceHealthPayer reported previously.

To learn more:
- read the announcement
- read the ReviveHealth Payor Trust Index

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