Trust issues will hold your system back: 5 ways for payers and providers to improve their relationships

Business-to-business trust levels in the healthcare industry rank among the lowest of all industries in the U.S. This may explain why the transition to value-based care delivery is crawling at a snail's pace.

During an Oct. 6 webinar, Brandon Edwards, CEO of healthcare specialist marketing communications agency ReviveHealth, and Dan Prince, president of healthcare research firm Catalyst Healthcare Research, discussed the results of their 10th Annual Trust Index survey, analyzed its findings and gave insight as to why trust matters in a value-based system.

How trust is measured
Researchers at ReviveHealth and Catalyst Healthcare Research developed a unique testing model to measure trust in business-to-business relationships. In 2016, 143 hospital executives and 602 practicing physicians participated in the survey. For the first time, the research firms also extended the survey to 74 health plan executives. In the case of the hospital and health plan executives, respondents were either C-suite executives or play a role in negotiating the managed care contracts that dictate service, delivery and payment models.

To measure trust levels, researchers broke the perception and experience of trust into three fundamental components: reliability, honesty and fairness. Providers and health plans were asked to indicate whether the opposite party could be counted on to:

  • honor commitments
  • represent itself and its intentions accurately and honestly and
  • abstain from routinely taking advantage of their business partner.

Answers were recorded on a five-point scale, from strongly disagree to strongly agree. Hospital executives and practicing physicians were asked questions pertaining to six major national health plans — Humana, Aetna, Cigna, UnitedHealthcare, BlueCross BlueShield, BlueCard and Anthem.

Health plans were asked to indicate their trust of academic medical centers, children's hospitals, for-profit hospitals, large nonprofit hospitals, small nonprofit hospitals, large physician groups and small physician groups.

The sad reality of payer-provider trust
This year's survey findings were dismal, at best. "If this was your child's report card, you would say these scores were failing grades," said Mr. Edwards.  

Hospital system executives' average trust levels in health plans ranged from 40.3 to 63.3 on a scale of 1 to 100. Physicians' average ratings for health plan showed less variability, falling between 52.7 to 57.2. Physicians' reported trust levels were noticeably lower than previous years, said Mr. Prince. "This drop in ratings suggests an intensifying frustration with health plans among physicians," he said.

But health plan executives reported significantly higher levels of trust in hospital systems and physicians than they received from their peers. Average trust ratings of providers ranged between 56.7 and 73.3. Interestingly, small physician groups and children's hospitals led the pack in terms of trust while large for-profit systems brought up the rear.

"Those organizations that are larger, hold market power and have more sophisticated negotiation infrastructures in place health plans perceived as the least trustworthy," said Mr. Edwards. Those organizations that have less market leverage or who may have less sophistication when it comes to negotiating rates appear to be considered the most trustworthy providers, he suggested.

What was most interesting about health plan trust levels in 2016 was the drastic movement of particular plans, said Mr. Edwards. Aetna, an insurer that has historically done well in the index, recorded the single largest increase in trust levels in any one year since the index was implemented. Blue Cross Blue Shield plans, another historically well regarded insurer, recorded the largest decrease in trust levels in any one year. This suggests Aetna dramatically changed how it approached and engaged providers, said Mr. Prince.

But Aetna's ongoing attempt to merge with Humana could disrupt some of its hard-won trust among providers. Mr. Edwards and Mr. Prince polled webinar participants as to how an Aetna-Humana merger could affect Aetna's trust scores. An overwhelming 78 percent of respondents said the merger would negatively impact the carrier's trust score, compared to 14 percent who said the impact would be neutral and 9 percent who said it would be positive.

How trust is holding back the transition to value
Only 13 hospital systems out of 80 respondents said they derived 10 percent or more of net patient revenue in 2015 from risk-based contracts, according to the survey. This figure reflects many healthcare professionals' realization that the journey to outcomes-based care delivery will be slower and more arduous than anticipated.

Both providers and health plan executives listed "trust" among the top five forces that would drive healthcare reform and among the top five factors prohibiting progress forward, according to the survey.

"In a highly regulated and complex industry, business-to-business trust is a crucial part of getting things done," said Mr. Edwards.

"When the industry's core businesses start to trust one another, then consumers can start to trust the industry," said Mr. Prince.

5 strategies for more effective business-to-business partnerships
Mr. Edwards and Mr. Prince shared five strategies hospital and health plan leaders should deploy to improve their relationships. 

  1. Know where you stand. Hospital executives should evaluate how their employees and stakeholders perceive the company's brand. Executives can do this by asking how stakeholders rate the company in terms of competency, consistency, communication and compassion. This gives leaders a chance to identify growth opportunities and better understand how to improve trust between parties and of their brands.

  2. Approach the payer-provider relationship in a new way. The traditional payer-provider model has produced increasingly combative results in recent years. Mr. Prince and Mr. Edwards recommend working in tandem with health plans to develop a custom, collaborative relationship.

  3. Start small, then scale up. Massive change is best tackled in small bites. Hospital leaders should begin implementing alternative business relationships slowly, enabling the company to build and expand on past success of such models as ACOs, P4P, bundled payments, etc.

  4. Find trusted partners for relevant data and technology. Data and analytics are crucial to effective population health management. Hospitals and health plans should contract with a third-party data and analytics firm both parties find trustworthy and reliable to enable the delivery of relevant, actionable data.

  5. Improve communication and information sharing. In some cases, the tools and technologies are not quite capable of facilitating seamless communication between parties. Explore communication and physician engagement strategies that get and keep stakeholders on the same page, build trust and facilitate transparency in their partnership to the best of their abilities.

To rewatch the webinar, click here

To download a copy of the webinar slides, click here

For more information on the results of this study, click here

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