NEJM survey spotlights payer-provider alignment barriers

A compass pointing to the word "Innovative"
Healthcare experts surveyed by NEJM Catalyst say the next round of innovation in value-based care provision will require better coordination between payers and providers. (Getty/Olivier Le Moal)

A lack of alignment between payers and providers continues to hamper the U.S. healthcare system as it strives to deliver higher-value care, according to a new survey.

More than three-quarters of the clinicians, clinical leaders and executives polled in the NEJM Catalyst Insights survey cited misalignments between payers and providers as a barrier to realizing improved value. Almost six in ten reported a lack of alignment in their own organizations.

RELATED: Lack of interoperability a major barrier to value-based care transformation, hospital finance executives say

The lone bright spot among respondents came from integrated payer-provider health systems.

While two-thirds of respondents saw progress from systems such as Kaiser Permanente, Thomas H. Lee, M.D., chief medical officer at Press Ganey and the NEJM Catalyst Leadership Board founder, says the care delivery innovation developed there has been “so much less than is possible, or that we are likely to see in the years ahead.”

To date, most of the momentum behind the shift from fee-for-service arrangements to a more value-oriented healthcare marketplace has been driven by large public players, particularly the Centers for Medicare & Medicaid Services, via programs designed to encourage risk-sharing and collaboration.

Survey respondents said further changes to regulatory models would provide the strongest incentives for payers and providers to improve their collaborative efforts.

RELATED: More providers enter joint ventures with insurers to create health plans

The report also suggests that providers see themselves at odds with payers, which they charge focus on reducing expenses to the detriment of patients. That sets up an adversarial dynamic in which providers feel the need to advocate on their patients’ behalf against payers’ proposed spending cuts.

To continue to move forward, respondents also suggest better alignment will be necessary not only among payers and providers, but also among other major stakeholders. A third of respondents see a lack of aligned incentives among stakeholders within an organization as the primary challenge to the transition to value-based payment methodologies.

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