How to Improve Provider Satisfaction and Enhance Payor-Provider Relations
Historically, the relationship between payors and providers is a complicated one. Though each group strives to provide what’s best for their patient community, maintaining a good working relationship isn’t always easy. Differing responsibilities, lack of communication, and financial pressures have long hindered a smooth rapport between these groups. Now, in the aftermath of COVID-19, both payors and providers are faced with new and unprecedented challenges that continue to disrupt an already tenuous relationship.
Here, we outline the factors that contribute most to this strained relationship in a post-COVID landscape, their effects on patient care, and how both groups can cultivate a healthier, more collaborative relationship that fosters positive outcomes for patients and a better functioning health system.
What causes strained relationships between payors and providers?
The COVID-19 pandemic has had a long lasting impact on every facet of the healthcare system, including the payor-provider relationship. Though obstacles in this relationship existed before the emergence of the virus, several post-COVID trends have created new burdens that are affecting the relationship. Some of these factors include:
- Excessive and burdensome administrative tasks that take valuable time away from patient care.
- Longer delays in time-to-credentialing for new provider applications and an increase in denials related to provider credentialing.
- Increased financial challenges and reduced revenue caused by lower patient volumes in elective procedures and outpatient services.
- Disruption in actuarial assumptions and financial modeling that warrant changes in payor contract pricing structures, reimbursement methodologies, and contractual terms.
- Reduction in performance-based compensations and financial incentives for providers.
- Fluctuations in patient enrollment and insurance coverage. Though the long-term financial effects of the pandemic are not wholly predictable, current trends suggest that employer-based coverages will continue to fluctuate in the patient population, leading to retroactive adjustments to claims and possible revenue loss for providers.
Why is provider satisfaction important?
The challenges above can lead to financial and administrative unpredictability, both of which can negatively impact provider satisfaction. Lack of physician satisfaction is one of the key indicators of provider burnout, which can have a significant impact on quality of patient care.
Provider burnout is nothing new. Medicine is a taxing career, but dissatisfaction in work-life balance among healthcare providers has increased significantly in recent years. One study involving more than 7,000 participants found that provider dissatisfaction in work-life balance was almost double that of the general population. Additional research shows that provider burnout rates are on the rise, with over 62% of physicians reporting burnout in 2021 compared to 45.5% in 2011.
Combined with COVID-related stress, some researchers have found that one in three providers plan to reduce their work hours while one in five providers plan to leave their current practice within two years. Burnout was also associated with significantly lower productivity in the field.
How can provider satisfaction be improved?
Improving provider satisfaction can encompass a variety of solutions. According to the results of one study of over 20,000 providers, reducing burnout and improving providers’ sense of feeling valued by their organization may work to improve clinician satisfaction and the overall efficiency of their healthcare systems. But how can one reduce burnout in an increasingly physically and emotionally demanding field? Improving the relationship between payors and providers may go a long way toward achieving this goal.
How can I improve my payor-provider relationship?
Reducing the amount of time providers spend on administrative tasks can help to build a healthier relationship between payors and providers, increase provider autonomy in the workplace, and improve the overall quality of patient care.
Here are some actionable items that can work to improve the payor-provider relationship and reduce provider burnout:
- Speed up the credentialing process with an automated solution: 54% of provider practices in 2021 reported an increase in credentialing-related denials. To improve the credentialing process and help providers get approved and in-network faster, innovative health insurers can rely on a provider intelligence solution like CertifyOS. CertifyOS leverages API technology to streamline and automate the credentialing process and save credentialing time. CertifyOS’ NCQA certified one-click credentialing solution is powered by hundreds of data integrations and powers credentialing timelines that are second to none, with 87% of files completed in less than one day.
- Reduce administrative task load with easier and faster payor enrollment: Administrative tasks can put mental, physical, and time-sensitive loads on a provider. Utilizing solutions that help to reduce the amount of time spent on administrative tasks can help to significantly improve burnout and subsequent quality of care. Specifically, automated provider data infrastructure solutions can help to enable easier and faster payor enrollment for providers. Using a platform like CertifyOS allows physician groups to hand off the end-to-end enrollment process, including submission, contracting, negotiation, and credentialing management. CertifyOS automates much of the paperwork needed for payor enrollment and shortens overall enrollment timelines, so providers know where they stand and when they can expect to be in-network.
- Improve prior authorization processes: Prior authorization requirements have been identified as a key source of provider burnout and dissatisfaction. Time spent navigating the submission and approval process needed for prior authorization can reduce the amount of time spent on patient care, and in some cases, become a health risk for patients when care is delayed. Streamlining the prior authorization process may help to make the system more efficient.
- Build and monitor value-based contracts: Establishing a collaborative relationship between providers and payor when building value-based contracts and monitoring its progress can help providers to better understand the quality metrics their performance is being measured against and provide incentives for value-based care.
Improving the functionality and efficiency of our healthcare systems requires open, communicative, and collaborative relationships between payors and providers. What’s more, payors and providers who leverage technology to streamline credentialing, enrollment, and other administrative tasks can give providers more time with their patients in support of better patient outcomes.
CertifyOS is a first-of-its-kind, API-driven provider intelligence platform that delivers frictionless credentialing, licensing, enrollment, and provider network monitoring. Our end-to-end solution leverages one easy-to-use platform that gives your team direct access to hundreds of curated data points and insights so you can reduce manual interventions, accelerate timelines, decrease administrative burdens, and improve payor-provider relations.
Want to learn more about how CertifyOS unlocks the power of provider intelligence to improve the relationship between payor and provider? Visit this page to learn more.
