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How Health Plans Can Rebuild Trust With Patients and Providers

Trust in healthcare is in decline. According to a recent report, patient and provider trust in the U.S. healthcare system fell by about 32% and 30%, respectively, during the pandemic. Although trust in clinicians remains high, one-third of providers do not trust their own healthcare organization’s leadership, and one-third of patients do not trust insurance companies. 

At the same time, patient expectations are shifting as a growing number of non-traditional players are offering consumer-centric health and wellness services. In this context, rebuilding trust is critical for healthcare organizations and insurance plans looking to evolve with the market and continue to deliver high-quality, highly valuable care. The key to achieving this is improving the payer-provider relationship.

The Rise of Trust and Value-Based Care

COVID-19 has exacerbated the “trust gap” within the healthcare system, but its roots can be traced back much further to the adoption of the fee-for-service payment model. In this model, providers are incentivized to perform a higher volume of services, and payers are incentivized to curb utilization and keep costs down. Over time, this misalignment has trickled down to patients. And once patients lose faith in the system, they are less likely to engage in preventive care, which is critical to detecting and managing chronic conditions.

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The Centers for Medicare & Medicaid Services is pushing for all traditional Medicare beneficiaries to be treated by a provider in a value-based care (or VBC) model by 2030. Payers and providers are being asked to share the financial risk for health outcomes and work together to reduce the cost of care while improving the quality. 

To succeed, providers will need to be able to access more data and glean actionable insights from it. But according to a recent survey, 36% of providers identified this as the biggest challenge in adopting VBC. Health plans are uniquely positioned to build stronger relationships with their provider partners and help them tackle data and other such issues. In doing so, they can go a long way toward repairing the trust gap.

Here are five areas where health plans can focus their attention to do just that.

5 Areas of Focus to Repair the ‘Trust Gap’

1. Invest in technology to help providers transition to VBC.

Payers are already working to help providers transition to VBC, such as offering upside-only benefits for three years. However, they could take this a step further by arming providers with the necessary resources to support a VBC infrastructure. For example, they could provide care-coordination payments to allow providers to invest in tools that help streamline data and make it actionable at the point of care. 

A Deloitte survey found that 62% of health system finance executives believe care coordination and quality of care will improve with data-sharing initiatives such as interoperability. Payers that assist in creating this infrastructure are likely to build goodwill with providers that often struggle with technology. This can also go a long way toward reducing the administrative burden for providers, a key contributor to burnout and a growing concern in healthcare.

2. Leverage retrospective strategies to benefit providers.

Retrospective services such as chart coding and EDPS submissions allow payers to work on behalf of providers that can’t afford their own risk adjustment coders. Savvy health insurance plans are working with experienced risk adjustment vendors that implement machine learning and natural language processing to help ensure providers are submitting the most accurate picture of patient health. 

Really savvy insurance plans assist with coding and documentation initiatives based on expert analysis. These plans work with providers to implement coding and documentation improvement initiatives based on expert analysis. Educating providers and supplying the tools they need to improve their coding literacy only helps enhance care delivery and therefore strengthens bonds with patients.

3. Focus on prospective strategies at the point of care.

As the number of Americans with chronic conditions rapidly increases, healthcare organizations must not only focus on delivering high-quality care to those who are sick, but also on improving patients’ health before they become sick. Although many health plans have retrospective programs in place, investing in prospective strategies that help monitor and capture risk factors at the point of care will also be critical. 

For example, prospective coding can alert providers earlier of patient health risks, allowing them time to coordinate preventative health services before an adverse event occurs. Payers that focus on ways to meet providers with information when they need it — at the point of care — will go a long way toward improving provider relations.

4. Find the right risk adjustment partner.

Guaranteeing that health conditions, health statuses, and all the necessary demographics are accurately documented is crucial for the VBC model to be successful. In reviewing options for risk adjustment partners, narrow the field to those that offer the tools and technology that

automate processes and provide interoperability solutions in an EMR-agnostic manner. 

Most vendors are capable of ingesting member data and analyzing it for trends. However, the right vendor can go one step further and leverage member data analysis to provide actionable insights that put the patient front and center. This way, plans can prioritize the most impactful interventions, improving both program performance and patient outcomes in the process.

5. Present a united front in patient-facing initiatives.

Given the current climate of mistrust, health plans must find every opportunity to foster trust and present a united front to the public at large. There are many examples of plans and providers working together for the patient’s benefit, offering services such as mobile mammogram booths in underserved areas or providing transportation and meals after major surgeries. 

By collaborating with providers on patient education initiatives and health drives, plans can improve patients’ understanding of medical conditions, care delivery, and even health plans.

Health plans that leverage these strategies to support providers in their transition to VBC can help increase patient trust in the system as a whole. As this trust rises over time, patients will be more inclined to cooperate fully with their providers and insurers alike, leading to improved financial and clinical outcomes — the best of both worlds for all involved.

Harshith Ramesh
Product Development and Global Operations at

Harshith Ramesh is primarily responsible for new product development and global operations at Episource, which provides services and products to simplify the way Medicare, Commercial, and Medicaid health plans manage their risk adjustment and quality programs. 

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