A survey designed to measure the level of trust that hospital executives have in health insurance companies finds several factors that contribute to low scores, including the length of time it takes for claims to be paid, and the rates hospitals and physicians are paid.
It may come as a shock, but new research confirms it: Healthcare providers do not trust payers.
Payers scored poorly on all three of the new trust questions in the annual National Payor Survey conducted by ReviveHealth, a Nashville, TN-based strategic communications firm and Catalyst Healthcare Research. The results from the final question, which asked providers whether a particular payer "balances its interests with ours and doesn't routinely take advantage of us," were particularly dire.
"I was surprised that the numbers were as bleak as they were on [that] last question," said Brandon Edwards, CEO of Nashville-based ReviveHealth. "It's very hard to lawyer your way around that, or to contract your way around that."
On a 1–100 scale, payers posted an average score of 47 on balancing interests with providers. "All scores were lower in this measure, suggesting a disconnect between the interests of payors and providers," the survey states.
ReviveHealth's "Payor Trust Index" crafted the trust questions in conjunction with Catalyst Healthcare Research. Slightly more than 200 health system and hospital executives participated in the survey, with respondents representing about a quarter of the country's hospitals, Edwards said.
High and Low Scorers
In addition to the question about balancing of interests, the survey asked whether a payer made "every effort to honor its commitments" and was "accurate and honest in representing itself and its intentions."
The survey found "the level of trust that hospital executives have in the health insurance companies they regularly deal with is abominably low."
A comparative bright spot, Bloomfield, CT-based Cigna, led the pack with a 63.1 composite trust score. The average score for all payers was 53.2, with Minneapolis-based UnitedHealth Group garnering a mark of only 40.7.
The low scores don't bode well. "Trust is a critical ingredient for the parties to work together," said Dan Prince, president of Catalyst Healthcare Research. "This means there's a long road ahead."
Cigna played up its relatively positive standing among its peers in a media statement, saying "While ReviveHealth's new Payor Trust Index paints a rather stark picture, we're pleased that Cigna is perceived as the most trusted health plan," said John Wray, senior vice president for delivery system innovation and collaboration.
Last place-finisher UnitedHealth had this to say: "This small, narrow, non-scientific survey misses several critical components of the positive relationships that UnitedHealthcare has with most hospitals. It is not indicative of the strong connections we have cultivated with our network of more than 800,000 physicians and 6,000 hospitals. These collaborative relationships with providers are at the core of our work to improve quality for patients across the country."
Results Not Unexpected
Several factors contributed to healthcare payers' collectively poor performance, "including the length of time it takes to get paid, and the rates hospitals are paid for their services," the survey states.
"But new factors also play a role. Narrow networks, tiering, and changing the terms of provider contracts are among the unilateral changes that payors are making right now."
A pair of healthcare provider executives familiar with the survey said the findings are disappointing but far from unexpected.
"It doesn't surprise me," Debi Hueter, VP for managed care at Atlanta-based Piedmont Healthcare, said this week. "Everybody is talking about different funding methodologies… But we really haven't seen flexibility on the other side."
Hueter says payers are often unresponsive to providers' market-specific concerns during contract negotiations. "Those are your marching orders," she said of the conditions some payers set for their provider networks. "Obviously, that doesn't fit every market, every area… They're taking that box, putting it on the provider's desk, and you take it or leave it."
Some healthcare reform efforts have contributed to perpetuating a historically prickly relationship, she says. "Narrow networks have driven the payers and providers farther apart… We're both struggling with exchanges and narrow networks."
Clint Hailey, senior VP and chief managed care officer at Dallas, TX-based Tenet Healthcare Corp., says providers and payers have been uneasy partners for decades. "It really has been that way forever," he said, adding that payers are in an unenviable position in US healthcare.
"They're in a tough spot. No matter how well they do, they start at a low point… Somebody's got to finance healthcare, and, for better or worse, health plans find themselves in that position a lot."
Hailey says the survey results are eye-popping given the pressing need for payers and providers to cooperate as they navigate the rapidly changing healthcare industry landscape. "It does scream for change," he said of the survey. "Something has to give. It doesn't mean they have to pay for more… What leads to relationships is mutual trust."
The Price of Mistrust
In strained individual human relationships, people either repair the damage or find new friends. Payers risk losing business partners and market share if they don't fix their broken images, Hueter said.
"They work for a for-profit Wall Street company. And you know there will always be an underlying we-have-to-keep-Wall-Street-happy mentality.
"We have to put the patient in the middle and decide what is best for the patient," she said. "It's got to be a long-term strategy, not a short-term strategy. That's just not in a payer's DNA…
"You will always have that yin and yang dynamic going on. We changed that by starting our own health plan, [with Wellstar Health System in 2012]" Hueter said. "We recognized change is coming down the pipeline. Every time we looked at our payer partners, they looked like deer in the headlights… We knew what we wanted to do. It's a physician-driven plan rather than a Wall Street-driven plan."
Christopher Cheney is the CMO editor at HealthLeaders.