Intelligent payer: Restoring provider trust

Trust hangs in the balance

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.

No trust, no influence

Poor provider trust undermines how payers can realistically influence providers in several key areas:

• Transitioning to value-based care. Payers want to shift more cost accountability to providers through alternative payment models. However, the adoption of risk-based contracts has been slower than hoped. Convincing providers who have zero risk today to enter downside-risk models is hard enough. Doing it without a foundation of trust is even harder.
• Improving the healthcare experience. Lackluster provider trust impacts payers’ ability to improve the healthcare experience. Payers do not directly engage with consumers during this part of the healthcare experience. Providers do. So, if payers want to influence this critical touchpoint, they need an integrated, trust-based provider relationship as a foundation.
• Driving efficiency back stage. A better trust pact between payers and providers can improve provider engagement and cooperation in strategic “back-stage” activities. These areas include network design and contracting, medication and disease management, and data sharing. Improvements here could drive better financial performance for payers.

How intelligent payers close the gap

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.

Good will hunting

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: