Payer-Provider Alignment

Greg Dorn, President & Mark Johnson, SVP Product Management

December 05, 2023


Deeper Dive into The Pulse of Payment Integrity 


The healthcare landscape is built upon the foundation of relationships, particularly between payers and providers. Yet, this crucial relationship has often been riddled with friction, particularly concerning payment integrity practices. At the heart of these challenges lies the need for a culture grounded in trust, mutual respect, and a shared commitment to lowering healthcare costs. While achieving a consistent win-win scenario might be ambitious, there’s significant room for compromise that serves the broader objective of
affordable care. This article delves into the heart of these challenges and reviews areas of tension and compromise that will guide the path to collaborative healthcare through deliberate, genuine actions by both payers and providers.

Payer-Provider Alignment key excerpts from our The Pulse of Payment Integrity Whitepaper.

Payers can address friction head-on and promote collaboration to improve relationships, creating more efficiency and accuracy in the long run. The 5 key factors that we have seen cause the greatest friction between payers and providers around payment integrity practices include:

  1. Payers and providers may have different priorities and goals, such as cost containment, quality of care, and patient satisfaction, that can lead to conflicting interests and tensions around payment issues.
  2. Incentives for payers and providers are not always aligned, leading to disagreements and causing friction in their relationship.
  3. A lack of trust and transparency in the payment process can lead to disputes, misunderstandings, and disagreements between payers and providers.
  4. Changes to policies and procedures without proper notification can lead to confusion and frustration for providers.
  5. A lack of education and outreach to providers about payment policies and procedures can lead to misunderstandings.

This payment integrity deeper dive looks into the payer and provider relationship, various impacts on patients, and strategies to strengthen the relationship. We trust our in-depth analyses continue to provide tools to help you enhance your payment integrity success.

Let's partner to a clear path to greater accuracy and cost savings.

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