Barriers to Transforming Healthcare: The Plight of the Provider

Much of the focus at AHIP Institute 2012 has naturally been on the issues that affect health plans and payers. However, one session in particular focused on some of the barriers and issues that providers face in today's complex healthcare environment.

Hal Teitelbaum, MD, JB, MBA, Managing Partner and CEO, Crystal Run Healthcare, led a presentation focused on what providers need to truly transform healthcare. He began by saying that he wasn’t entirely certain that payers want to move forward with the process of transforming the current healthcare system, saying that he has heard very little about payers expressing interest in partnering with providers in order to improve value.

“At the end of the day, if we are going to get to a value-based system, it’s going to take a deep conversation between providers and health plans and that is not happening the way it should be,” said Dr. Teitelbaum.

Another issue that Dr. Teitelbaum spoke about was the difficulty that providers have in acquiring data from health plans. He mentioned that these health plans have the most sophisticated systems in healthcare, as well as access to data that providers do not, such as the claims data. Yet, in those instances when providers are actually able to get the data, it is often times in different languages, not formatted in an easily understandable way, it is so old that it is no longer actionable.

If payers were able to assist providers with actionable data in real time, Dr. Teitelbaum believes that this would be a very significant step forward in transforming the delivery of care. “If payers and providers don’t stop talking at each other and being adversaries, health plans will be little more than commodities and providers will be little more than well-trained technicians,” he said.

It seems as though the issues that Dr. Teitelbaum speaks about are more prevalent in certain geographic areas; however, it is clear that payers and providers must make more of an effort to help one another and work together if there is going to be any real improvement in healthcare outcomes and costs.

To learn more about this session, please visit the AHIP Institute 2012 website.