A survey of more than 600 primary and specialty-care physicians across the U.S. suggests mistrust of major insurance companies is an issue across the industry.
With many MDs taking the view insurers are an impediment to the provision of quality care, that dynamic could impact coordination of care and risk-based arrangements that require a level of partnership between health plans, hospitals and physicians, Brandon Edwards, CEO of ReviveHealth, told Healthcare Dive.
The 2015 ReviveHealth Payor Trust Index polled respondents on six of the top national insurers and ranked them in order of trust, with UnitedHealthcare at the bottom and Blue Cross Blue Shield plans at the top.
Trust was measured through several factors, including physicians' perspectives on a health plan's efforts to:
- Honor its commitments;
- Be honest and accurately represent itself and intentions; and
- Not routinely take advantage of physicians.
It found the top factor influencing physician opinion on whether health plans help or hinder care was the perception of more coverage with fewer claims denials versus poor coverage with more claims denials.
ReviveHealth has done a similar trust index for the last nine years regarding trust between hospitals and insurers, but this was the first year they expanded the effort to capture physicians' direct input.
"We felt like it was a missing piece of the picture," Edwards said. This effort sought to uncover whether physicians saw things the same way as hospitals, what the differences would be, and what roadblocks and opportunities might exist for those relationships from a trust standpoint.
The results suggest that compared to the hospital sector, physician trust in aggregate is slightly better than that between hospitals and health plans. "Which is good news overall," Edwards said, "and probably reflects that health plans treat physicians a little bit better than institutions like hospitals."
However, trust between physicians and health plans compared to trust levels in other industries is "pretty dismal," Edwards suggested. "The ratings we experienced in this survey put these trust levels in the bottom 15% to 20% of industries nationwide," he said.
Edwards argues trust in this sector is increasingly critical as healthcare and health insurance entities move into more of a risk environment. "I'm not going to take a risk with someone I don't trust-or at least be super reluctant to do it," he said.
The rankings, which ranged from trust levels of 56.5 at the bottom to 60.5 at the top, did somewhat exceed the consumer trust level in health plans recently reported by the 2015 National Healthcare Trust Index, which found only 49% of consumers said they trust their health insurance plan.
The ReviveHealth Payor Trust Index released the following physician trust scores for national health plans:
- BCBS - 60.5 (compared to health system rating of 59);
- Cigna - 58.6 (compared to health system rating of 62.7);
- Aetna - 58.2 (compared to health system rating of 54.8);
- Anthem/Wellpoint - 57.6 (compared to health system rating of 46.9);
- United - 57.1 (compared to health system rating of 40.5); and
- Humana - 56.5 (compared to health system rating of 51.3).
Rankings aside, the numbers suggest all the plans could do better, Edwards said. "I think it's hard to look at scores in the 50s and 60s and not see room for improvement."
However, he sees the data as promising. He suggests the takeaway is the national health plans can look to how independent Blues plans have treated physicians and focused on supporting them in the delivery of high quality care as a roadmap for better and more successful relationships.
"Anything these plans can do to show they're trying to support physicians with tools and data, and even holding them accountable, but doing so in a way that seems genuinely focused on care and not just on scores, is going to make the right impression," Edwards said.
He went further to suggest employers and cities should factor trust data into health plan selection processes.
"If ultimately what I'm relying on my health plan to do is to deliver to me, as a member and an employer, a network of providers who are going to be focused on the right things, it's going to be really hard for a health plan that isn't trusted to deliver the same value as a health plan that is."
The Blue Cross Blue Shield Association and two other insurers from the rankings list declined to comment.