Resources
Takeaways
The lay of the land
- Health plans historically integrated horizontally but now are integrating vertically, expanding their power within the healthcare industry.
- Growing payor reach and control creates a power imbalance that allows payors to force providers into minuscule reimbursement rates. This power imbalance works to the detriment of healthcare consumers.
Trust Index results reach rock bottom
- For the last 12 years, ReviveHealth has published an annual Trust Index report which measures the level of trust between payors and providers based on honesty, reliability, and fairness. The Index represents 40% of the hospitals in America.
- This episode of The No Normal Show examines this year’s results featuring health plan executive turned whistleblower, Wendell Potter.
- We thought that COVID-19 would rally the entire healthcare industry to solve problems together for the common good. Instead, the Index showed the greatest decline in trust in the past 12 years – a 34% decrease year over year.
Uncovering the factors at play
- Health plans influence policy and the public through massive and expensive lobbying campaigns. This practice shifts blame for exorbitant healthcare costs to providers.
- Health plans unilaterally alter language in provider manuals that fundamentally reduce how much they reimburse providers for care.
- Health plans are accountable to shareholders, which means that their core objective is to turn a profit and lower utilization costs.
- Health plans are increasingly denying claims or requesting retroactive analysis with little explanation while also increasing prior authorization requirements and out-of-pocket costs. This delays treatment and increases costs for providers.
