June 28, 2017 – A survey conducted by Availity, the nation’s largest real-time health information network, found that while payers and providers want to collaborate more closely on value-based care initiatives, such partnerships remain vulnerable to poor data transparency, competing business goals, and significant administrative burdens.
The survey, which included responses from 40 health plans and more than 400 practice- and facility-based providers, indicates that a majority of all groups believe that improved collaboration will lead to greater profitability. However, many of the same data-sharing and administrative issues endemic to fee-based healthcare are present in value-based initiatives.
A solid majority across all groups (an average of 76%) viewed administrative waste as a significant contributor to ongoing communication problems. Among the top issues for providers were redundant information requests, denied claims, and inconsistent rules.
“Providers communicate, on average, with 17 to 20 payers a week, so the problems associated with administrative waste can have an amplifying effect,” said Brian Kagel, Availity’s Director of Market Research. “Often, representatives from multiple payer units will unknowingly contact a provider seeking the same information, leading to provider abrasion. Until providers and payers can address this challenge, it may be difficult to accurately measure value-based outcomes.”
Online and multi-payer portals were viewed as promising—if currently underutilized—solutions to improve communications and mitigate costs. Payers show interest in online portals, with 25% indicating it would be the preferred method of communication with providers. A multi-plan portal was preferred by 35% of practice-based providers and 42% of facilities-based providers.
However, for more than 90% of providers and 68% of health plans, the phone remains the most common communication channel, with long wait times being viewed as the key weakness of that channel.
As for collaborative opportunities, patient/member satisfaction was viewed as a significant priority for a majority of payers and providers. There was consensus among all surveyed groups that in the age of high-deductible health plans patients need to better understand their benefit information and financial obligations. Fifty-one percent of practice-based providers and 61% of facility-based providers consider patient communication—specifically in regard to understanding benefits and financial responsibilities—to be a challenge.
“Trust is essential to building a successful payer-provider relationship. When both parties come to the table with an open mind, and a common platform, they can focus on creating alignment in several key areas,” said Jeff Chester, Senior Vice President and Chief Revenue Officer of Availity. “Establishing a transparent and collaborative relationship between payers and providers will ease costly and inefficient burdens for both stakeholders and foster the rich, actionable information to ensure that value is achieved throughout the continuum of care.”