Intelligence Report: Payer-Provider Strategies

This HealthLeaders Media research report reveals that while there is evidence of improved relations, trust still has not fully enveloped the payer-provider dynamic.

This article first appeared in the March 2015 issue of HealthLeaders magazine.

When asked whether the results of the HealthLeaders Media Payer-Provider Strategies Survey warn of contentious relationships and indicate the presence of an emerging foundation for sharing risk, Alan J. Murray, president and CEO of North Shore-LIJ CareConnect Insurance Company, Inc., of East Hills, New York, says, "I don't necessarily see that there is a seismic shift in the trust level."

CareConnect is a provider-owned health plan that was created by North Shore-LIJ Health System in 2013, with a network that includes more than 16,000 providers at hospitals and physician practices throughout downstate New York. A key point of interaction between payers and providers has been the submission of claims by the provider and the adjudication and payment of claims by the payer. These are not simple transactions—they reflect both the complexity of care and the complexity of the insurance business.

Although some of the back-and-forth is due to errors on the part of one side or the other (e.g., coding errors), as Murray suggests, trust can be a problem. More than one-third (39%) of providers say that trust with commercial payers needs to be improved.