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Physician Satisfaction With Health Plans: Results From a National Survey
Natasha Parekh, MD, MS; Sheryl Savage; Amy Helwig, MD, MS; Patrick Alger, BS; Ilinca D. Metes, BS; Sandra McAnallen, MA, BSN; and William H. Shrank, MD, MSHS

Physician Satisfaction With Health Plans: Results From a National Survey

Natasha Parekh, MD, MS; Sheryl Savage; Amy Helwig, MD, MS; Patrick Alger, BS; Ilinca D. Metes, BS; Sandra McAnallen, MA, BSN; and William H. Shrank, MD, MSHS
Several physician and payer characteristics are associated with physician satisfaction with health plans. There is opportunity to improve physician satisfaction with payers, specifically in pharmacy.
Our finding that primary care physicians rated finance and utilization/quality management domains higher than did specialists could be related to multiple factors. First, specialists may be more affected by utilization management than primary care physicians, specifically those in procedure-based specialties whose relative value units and incomes are based on procedures that require prior authorization from health plans. Second, new alternative payment models that prioritize value over volume may disproportionately benefit primary care physicians over specialists.18 Additionally, because primary care is more heavily influenced by payment reform, health plans potentially have had to intensify their outreach efforts with primary care providers more so than with specialists.

Limitations

Our study has limitations. First, we could not include plans that use customized provider satisfaction surveys because responses could not be fairly compared. Therefore, the potential for selection bias exists for plans that chose standardized surveys because they may not be representative of all plans. Second, the response rate for the survey was 12.6% among providers. It is unclear how our responders might differ from nonresponders, and our responders may not be representative of all physicians responding for all health plans: Although our physician years of experience and practice size seem to be reflective of the general physician population19,20 and health plan size distribution and vertical integration status seem to be reflective of the general health plan population,21 our representation from primary care physicians is higher than primary care representation in the United States.20 Importantly, we adjusted for whether physicians were primary care providers versus specialists in our multivariable model (Table 2) and display adjusted means for primary care and specialist physicians separately (Figure 3). Similarly, selection bias may exist among physicians, in that physicians who may be more or less satisfied with respective plans might complete these optional surveys more frequently. Interestingly, although we anticipated that providers may be more likely to respond to surveys when a higher proportion of their patients were enrolled in sponsor health plans, this was not the case; most providers had less than 20% of their patients enrolled in respective plans, likely because the majority of providers’ patients were represented by more than 11 health plans (Table 1). Nevertheless, we adjusted for differences in the proportion of patients represented by sponsor health plans in our multivariable models. Despite potential selection bias, to our knowledge, no other study has assessed such a large volume of physician satisfaction surveys.3,11 Finally, although we adjusted for regional differences, certain regions had very little representation by plans. For example, 0 plans were associated with region 8 (Denver), whereas 21 plans were associated with region 9 (San Francisco).

CONCLUSIONS

To our knowledge, this is the first study to assess contextual factors associated with provider satisfaction with health plans. As part of the largest physician satisfaction study to date,3,11 our results contribute to a growing foundation of work related to contextual factors associated with provider satisfaction. Our findings have important implications for policy and practice. We demonstrate that provider ratings of health plans were, in general, low. As provider satisfaction is increasingly recognized as crucial for health systems, significant opportunity exists to improve the relationship between providers and health plans. In 2005, the Association for Community Affiliated Plans collaborated with The Commonwealth Fund to identify best practices for health plans to recruit and retain providers.22 These best practices include improving payment practices, incentives, and financial assistance for claims; strengthening referral and authorization practices through streamlining processes and incorporating technology; improving communication through in-person meetings and regular written communications; simplifying administrative burdens, such as credentialing, eligibility requirements, and data required for encounters; and enhancing support for high-risk patients, including assistance with patient transportation, child care, and interpreter services. Importantly, the report did not address health plans’ approach to pharmacy. Our findings build on these existing recommendations by suggesting that plans could additionally focus on their formulary consistency, availability, affordability, messaging, prior authorization procedures, and ease of navigation to improve provider satisfaction.

Taken together, rather than exacerbating physician burnout through administrative burden, documentation requirements, and cumbersome utilization management processes, our findings suggest that health plans have an opportunity to improve physician satisfaction through prioritizing provider relationships, reducing administrative burden, and strengthening resource support. As physicians are required to adapt to a rapidly transforming healthcare landscape, it will be imperative for health plans to prioritize physician satisfaction moving forward.

Author Affiliations: University of Pittsburgh Medical Center (UPMC) Center for High-Value Health Care (NP, WHS) and Insurance Services Division (NP, AH, SM, WHS), Pittsburgh, PA; Division of General Internal Medicine, University of Pittsburgh (NP), Pittsburgh, PA; SPH Analytics (SS, PA), Alpharetta, GA; University of Pittsburgh Graduate School of Public Health (IDM), Pittsburgh, PA.

Source of Funding: None.

Author Disclosures: Dr Parekh is employed by the UPMC Center for High-Value Health Care within the UPMC Insurance Services Division. Dr Helwig and Ms McAnallen are employed by the UPMC Insurance Services Division. Dr Shrank was employed by the UPMC Insurance Services Division during the development, analysis, drafting, and acceptance of the article. The remaining authors report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article.

Authorship Information: Concept and design (NP, AH, WHS); acquisition of data (SS, PA, SM); analysis and interpretation of data (NP, SS, AH, PA, IDM, WHS); drafting of the manuscript (NP, AH, WHS); critical revision of the manuscript for important intellectual content (SS, AH, IDM, SM, WHS); statistical analysis (NP, PA, IDM); administrative, technical, or logistic support (SM); and supervision (SM).

Address Correspondence to: Natasha Parekh, MD, MS, UPMC Center for High-Value Health Care, 600 Grant St, 40th Floor, Pittsburgh, PA 15219. Email: natashaparekh1@gmail.com.
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