Physicians Cite Health Insurance Companies as Barrier to Patient Care

Physicians broadly mistrust healthcare insurers and believe they interfere with physicians’ ability to provide high-quality patient care, according to the ReviveHealth Payor Trust Index: Physician Perspective, which polled 605 physicians (25% primary care, 75% specialists) from 45 of 50 states and the District of Columbia. The poll also found that physicians rated local BlueCross/BlueShield plans as best at enabling the delivery of high-quality care, and UnitedHealthcare (United) and Humana as the worst.

This was the first time the Payor Trust Index was extended to physicians; previously only health system executives were polled on their experience of doing business with the nation’s largest health plans. The Payor Trust Index asks questions examining various issues related to trust, assigning a numeric score from 1 to 100 to the answer. Physician trust in the nation’s largest insurers was 58.1 out of 100 (average of all combined scores); this is slightly higher than the 51.8 average score that hospital leadership gave insurers in the 2015 National Payor Survey from May 2015.

The Payor Trust measured physician perspectives on health plans’ efforts to honor commitments, whether they accurately represent themselves and their intentions, and whether they took advantage of physicians. The top factor cited by physicians as influencing their opinions about whether health plans help or hinder delivery of high-quality healthcare was more coverage and fewer claims denials versus poor coverage and more claims denials.

When considering justifications for the “best” ratings, 5 of the top 6 criteria were relationship driven: the best rankings were based on customer service, administration, and clear guidelines. Only one criterion was financially driven. Similarly, of the “worse” ratings, all of the top 5 criteria were relationship factors; payment rates were brought up as the sixth most important factor.

Physician mistrust of health plans will likely only get worse with the mega-merger deals of the nation’s largest health plans now being reviewed by the US Department of Justice (DOJ), according to ReviveHealth Sounding Board Member Nathan S. Kaufman, an expert in payor-provider relationships.

“The Affordable Care Act [ACA] and other market forces have restricted growth in insurance premiums,” he said. “Market power continues to be the primary driver of how healthcare dollars are distributed. If physicians think health plans are difficult to deal with now, just imagine negotiating with a company comprised of two of the largest, least-trusted ones, which is what we’re looking at right now with the planned mergers involving Human, Anthem, and others.”

DOJ is currently reviewing $100 billion in blockbuster mergers between Anthem and Cigna and between Aetna and Humana, which could potentially reduce the number of major, national health plans from 5 to 3. Physicians, politicians, and consumers have voiced concerns about the effect such mergers would have on competition and prices, and the potential to undermine the ACA.