HFMA 2017: Provider-payor collaboration limited by phone calls, administrative waste

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Providers and payors want to work together on transitioning to value-based care. What gets in the way is poor communication and time wasted on redundant administrative tasks, according to a Availity survey released at the Healthcare Financial Management Association (HFMA) conference in Orlando.

40 health plans, along with 201 practice-based primary care physicians and specialists and 203 C-suite leaders at hospital or health system-based providers participated in the survey. All groups seemed to agree greater collaboration would lead to greater profitability, a view expressed by 85 percent of health plans, 77 percent of facility-based providers and 74 percent of practice-based providers.

Poor communication, however, is viewed as the greatest barrier to that collaboration, with much of it blamed on administrative waste. An average of 76 percent of all respondents said a significant contributor to those problems are issues like redundant requests for information, denied claims and uncompensated care and inconsistent rules among health plans.

“Providers communicate, on average, with 17 to 20 providers a week, so the problems associated with administrative waste can have an amplifying effect,” said Brian Kagel, Availity’s customer experience and market research leader. “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 will be difficult to accurately measure value-based outcomes.”

One of the reasons for this frustrating communication could be how providers and health plans are talking to each other. Ninety percent of providers and 68 percent of payors said phone calls remain their primary means of communication. Sixty percent of health plans said they’d prefer to use online portals, but only 39 percent of practice-based providers and 40 percent of facility-based providers felt the same.

Providers did point out ways they could be convinced to change their preferred communications method. The majority in both facilities and practices said ease of use, reducing staff time spent on communications, providing value for cost and support from vendors would factor into their decisions to adopt communications products.

As for where providers and payors should be collaborating, all groups said patient/member satisfaction should be a priority, as higher deductibles require patients to be more aware of what plans cover and what they’ll have to pay. For providers, having knowledgeable staff interacting with patients is the most important step for improved patient satisfaction, followed by two areas where payors could help: accurate billing and a smoother pre-authorization process.

“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 Russ Thomas, CEO 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.”