Closer provider-insurer ties bring new challenges

Increased collaboration between providers and payers is inevitable, but that doesn't mean the future financial interests of these oft-warring parties will align, healthcare leaders say.

In fact, future financial negotiations may be tougher than in the past, even as providers and payers work more closely together in sharing patient and financial information, according to the majority of those surveyed in Modern Healthcare's third-quarter CEO Power Panel poll.

A whopping 88% of the 58 CEOs surveyed foresee more collaboration between providers and payers in the next three to five years. The increase will come largely from a sea change in reimbursement—the ongoing movement from volume to value-based payment systems. But at the same time, nearly 3 in 4 CEOs say the movement toward value-based reimbursement models also will produce “more complicated negotiations between payers and providers” over rates.

“If we're going to actually move at a reasonable pace from a marketplace based on volume to one based on value, everyone is going to have to work together,” said Barclay Berdan, CEO of Arlington-based Texas Health Resources. “Both providers and payers have a relatively simple choice: They can preserve the status quo or they can innovate. I think the payers and the providers are going to be innovating.”

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