Intelligent payer: Restoring provider trust
May 14, 2019
May 14, 2019
The fact that only one in 10 providers has strong trust in the health payers they work with points to a serious trust gap that can impact payers, providers and consumers too. This gap also makes it difficult for payers to exert the necessary influence on providers to drive critical strategic objectives forward. Mending one of the most important relationships in healthcare will take intelligent payers using human-centered design and artificial intelligence (AI) to transform payer-provider interactions and the payer operations that underpin them.
Payers and providers have a mutually-dependent business relationship that touches all experience areas of the healthcare continuum—pre-service, care delivery, care coordination, and claims and payments—with healthcare consumers as shared customers (see Figure 1). What’s lacking in this relationship is strong trust, which is a liability.
Accenture research shows that an overwhelming majority (86 percent of providers do not have a strong degree of trust in the payers they work with. Moreover, payer Net Promoter Score® (NPS®) from providers is a dismal -52, which is significantly lower than the scores from all other payer stakeholder groups (see Figure 2). With such an extremely low NPS, it is not surprising that providers view payers as negatively impacting their work. Just 10 percent strongly agree that payers contribute to their professional satisfaction.
Poor provider trust undermines how payers can realistically influence providers in several key areas:
The best place for payers to start tackling the trust gap is by focusing on areas driving the greatest frustration. These center largely on payers’ inability to arm their providers with complete, accurate, and timely cost and quality reporting data (see Figure 3).
As payers seek friction-free data sharing with providers, AI will be an invaluable enabler. It can modernize processes, help improve long-term clinical outcomes and deliver new value for payers. US health insurers can unlock $7 billion in total value in 18 months using AI-powered solutions. Sixteen percent of this operating income savings ($1.1 billion) comes from using AI to manage and support reimbursement. And another 14 percent ($1 billion) comes from streamlining processes associated with managing networks and providers. Accelerating prior authorization and clinical review of claims is a leading area for intelligent payer solutions to improve providers’ experiences, and with that, their trust.
Instead of approaching their provider relationships like transactional, supply chain ones, payers would be wise to start thinking about provider experiences in the same way they do healthcare consumer experiences. Here’s how:
Use human-centered design to structure processes and map interactions that focus on the needs of providers.
Offer tools to provide more accurate data that providers typically build or buy elsewhere.
Improve back-stage activities like prior authorization processes, claims disputes and other functions.
Apply AI and intelligent payer solutions to improve provider and patient interactions and operations.
Improve the quality of the data offered to providers to improve performance and influence collaboration.