2020 Industry Pulse Report: Alignments and Asymmetries

Payer and provider alignment is essential in moving healthcare forward. Results from Change Healthcare’s 2020 Industry Pulse Report indicate that, although payer and providers are aligned in some areas of healthcare improvement (i.e. Social Determinants of Health, tactics to improve consumer engagement, and the potential for artificial intelligence and machine learning), divisions persist in key areas like value-based care, consumerism, and interoperability.

Change Healthcare and the Healthcare Executive Group have partnered to issue their annual survey each year for the past 10 years, determining healthcare executives’ outlook on the industry for the coming year. Results released in the first quarter of the new year shed a light on executive’s anticipated challenges, issues, and opportunities.

According to the report, 445 payers and providers responded to the report analyzed by InsightDynamo (an independent healthcare market strategy and research company), making this year’s the largest cohort in the research’s history. 

Change Healthcare highlighted five key takeaways from the study, including value-based care, the implementation of “consumer-centric” strategies, healthcare interoperability, perceived benefits of artificial intelligence (AI) and machine learning. 

Value-based Care

Payers said that they are much farther along on the path to value-based care than their provider counterparts, with 62 percent indicating that their organizations are already using alternative payment models and 9 percent saying their organizations are using full capacitation. Conversely, 43 percent of providers reported using alternative payment models and only 2 percent said their organizations were at full capacitation.

Providers were also significantly more likely than payers to have less than 10 percent of their revenues derived from a value-based care model. 

Top-cited barriers to achieving a value-based care system include: from providers, unclear or conflicting performance measures (29 percent) and regulatory changes/political uncertainty (18 percent; and from payers, a lack of or limited IT infrastructure (25 percent). 

Full “consumer-centric strategy”

Only 18 percent of providers and 24 percent of payers indicated that they have such a strategy in place. Fourteen percent of payers said that they do not have such a strategy, but all payer respondents said they at least have one in development if not already in place. 

Regarding consumerization efforts, 34 percent of providers and 43 percent of payers indicated that their efforts were “nascent”, while 36 percent of providers and 33 percent of payers indicated their efforts were in an intermediate phase

According to Change Healthcare, payers and providers tended to disagree on who is best positioned to provide cost and quality data to consumers. Unsurprisingly, both believe they are the best choice. Averaged from all respondents, 31 percent feel that payers are better suited to provide cost and quality data to consumers, whereas 58 percent feel providers are betting suited to support the consumer along their patient journey. 

Regarding the information they provide to consumers, payers (84 percent) were far more likely to provide government-driven ratings than providers (68 percent); however, providers (56 percent) were more likely to provide consumer reviews than payers (25 percent).

Collectively, both payers and providers said that plain-language EOBs and simplified benefit explanations were the top financial and billing improvements that would drive consumer satisfaction. Individually, payers placed a greater emphasis on the elimination of surprise billing and providers placed a greater emphasis on in-network vs out-of-network providers. 

Payers and providers also selected the same top five non-clinical improvements that would drive consumer satisfaction, respectively: online appointment scheduling; medical information in layman’s terms; consumer access to EHR and provider notes; telehealth and other remote access options; and non-clinical services like transportation, nutrition, housing, and more.

Providers (24 percent) also thought that patients’ ability to capture their experience with their physician in audio or video formats would also increase satisfaction, compared with 18 percent of payers that thought the same.

Healthcare Interoperability

This is an area in which payers and providers are still divided, according to the results of the survey. 

Aspects of healthcare that 36 percent of payers and 20 percent of providers ranked most likely to drive influence toward healthcare interoperability are regulatory changes. 

Nearly a quarter of providers and 11 percent of payers think that consumer demand will be the greater driving force for healthcare interoperability. Similarly, 40 percent C-suite executives think consumer demands will push interoperability, but only when consumers insist upon it. 

The third-highest potential driver of healthcare interoperability were physician-led initiatives. 

AI Benefits and Machine Learning Investments 

Overall, both payers and providers are well aware of the potential benefits of AI and machine learning capabilities and are aligned in this area. Thirty-eight percent of payers and 56 percent of providers said smart technologies will improve healthcare efficiency. Similarly, 28 percent of payers and 42 percent of providers said such technologies would reduce costs. Both payers (36 percent) and providers (39 percent) reported payoffs with the use of these technologies. 

2020 Elections

C-suite respondents (39 percent) do not anticipate any significant changes that will affect healthcare as a result of the 2020 elections; generally, 28 percent of respondents feel the same. 

Here, providers and payers were at odds again: 31 percent predict a continued unwinding of the Affordable Care Act (ACA), whereas 26 percent of payers think it will be strengthened throughout the election cycle. The prospect of a public option healthcare is low among payers and providers-collectively, only 17 percent thought a public option. Furthermore, only three percent predicted a single-payer “Medicare for all” system."

Change Healthcare will be holding a webinar to dive deeper into the results of their survey on February 25^th. Register here to save your seat.