Providers Report Low Levels of Trust in Healthcare Payers

Success in value-based care requires collaboration between payers and providers. They must work together to negotiate the terms of the contract, including outlining the quality metrics and incentives used to reimburse providers.

Despite the growing buzz around value-based care across the industry, many clinicians are still hesitant to dive into some of the riskiest models like downside risk or capitation. Previous work from Insights by Xtelligent Healthcare Media revealed that while many industry leaders believed value-based care would positively impact their organization, downside risk-based models were still far away for many organizations.

These heavily risk-based models require high levels of collaboration between providers and their payer partners, both private and public. Success in these models means the two parties must iron out the specific terms of the agreement, including quality incentives, payouts, and benchmarks for success.

But payers and providers are often not on the same page. They define quality and value differently and many providers are hesitant to jump into risk-based models because they do not understand exactly what their payers are asking of them.

To further understand provider views on value-based care and their relationship with their payer partners, Insights conducted a survey of providers. The audience included primary care physicians, specialists, advanced practice providers (APPs) such as nurse practitioners and physician assistants, and nurses.

Highlights from the survey reveal that many providers have low levels of trust in their relationships with private and public payers. In fact, 16 percent of specialty care physicians have no trust in their private payers and 11 percent have no trust in their public payers.

Primary care physicians felt similarly, as 17 percent and 18 percent lacked any trust in their public and private payers, respectively. While APPs and nurses felt more neutrally about their payer relationships, the overall trend shows minimal trust in these critical relationships.

A large part of this limited trust is likely due to a lack of communication between providers and payers. Overall, 32 percent of respondents had no communication with their private payers and another 38 percent had no communication with their public payers.

Not communicating with payers means providers must understand the complexities of their contracts and figure out how to succeed by themselves. Rather than work together towards a common goal of value, providers feel they are left on their own.

After the survey was complete, respondents were asked if they were willing to complete qualitative follow-up on the survey’s results. Four interviewees provided context for the survey’s findings, highlighting real-world challenges related to working with payers on value-based care models and articulated key strategies for success.

“The biggest barrier in healthcare is that people do not want to work together for a common good,” said one nurse practitioner at a non-profit teaching hospital. “I’m concerned that if we continue to have this egotistical view, we’re going to miss out on opportunities and it’s going to really change the whole view of healthcare.”

The first step in succeeding in value-based care models is a shared understanding of value and quality between payers and providers. Payers have an obligation to understand how providers view these contracts and their ability to succeed in these models. Only when payers and providers are on the same page and understand each other will the industry truly be able to transition fully to value-based care.

Provider Perceptions of Value-Based Care also highlights provider motivation for participating in value-based care models, provider satisfaction with their private and public payer relationships, organization concerns with cost transparency, and challenges to collaborating with payers. The full report can be found here.