Nine healthcare leaders joined Becker’s to discuss the one message they wish insurers would understand about the realities of delivering care
Question: If you could communicate one thing to payers about the realities of delivering high-quality care, what would it be?
Editor’s note: Responses were edited lightly for clarity and length.
Chacko Alappatt, MD. Medical Director of Arthritis and Osteoporosis Center of Southwest Ohio (Miamisburg): Providing high-quality patient care requires adequate staffing. Since payments are taking longer and are considerably lower, we are having a hard time competing with other hiring entities like hospital systems for the best staffing. Also, we are diverting some of our staff resources to back office duties like collecting funds rather than focusing on hiring and optimizing front office administrative and clinical staff members.
Maya Babau, MD. Neurosurgeon with Cleveland Clinic Martin Health (Stuart, Fla.): Each patient is different, and patient-centric care is a must. We need to have enough flexibility in our care delivery to provide the right treatment at the right time for the right patient.
Antonio Hernandez Conte, MD. Immediate Past-President of the California Society of Anesthesiologists: Anesthesiologists have a long-standing reputation for protecting patient safety, improving health care quality and reducing health care costs through patient-specific anesthetic techniques, perioperative pain management and surgical care coordination. Anesthesiologists work collaboratively and proactively with hospitals and health systems to ensure the highest standards of anesthesia care are in place to optimize outcomes and ensure patient safety throughout a patient’s entire perioperative journey. Insurance companies need to realize that anesthesiologists will also work with insurers to implement best practices and ensure greater transparency for patients. We also believe that insurance companies should seek feedback and input from state and national anesthesia organizations, as well as their local anesthesia groups prior to rolling out ill-conceived policies that reflect an embarrassing lack of understanding of anesthesiologist-led care models and anesthesiology payments that harm the reputation of their health insurance companies. At the end of the day, insurance companies have a responsibility to enable access to high-quality healthcare for their patients and members. Most importantly, insurance company profits should never occur at the expense of patients or by jeopardizing quality of care and patient safety.
Harry Haus, MD. Family Medicine Physician (Erie, Pa.): I was a medical director for Cigna and also for Blue Cross Blue Shield. Quality care is not considered. At both insurers I was told to deny care and if the patient really needs care they can appeal to get it. People making the rules about payment have not taken care of a patient for years after residency. In some cases they only treated patients for a year 30 years ago. Many medical directors of payers have not seen a patient for 25 years. What is called quality by insurance often has nothing to do with quality.
Corey Koenig, MD. Anesthesiologist at Providence Anesthesiology Associates (Charlotte, N.C.): Payers often give a canned response about wanting high-quality care. The truth is that they really want the cheapest care. Payers are unwilling to engage in any quality-linked reimbursement because they ultimately care about their shareholders more than the patients. When was the last time their members had their premiums reduced? Anesthesia reimbursements have been slashed, so are those savings passed on to the patients or was it to the executives and shareholders through year-over-year record profits? I think we all know the answer.
Robert Pearl, MD. Professor of Plastic Surgery at Stanford (Calif.) University Business and Medical School: You can’t address the high costs and mediocre quality of American healthcare by restricting medical care through prior authorization and claims denials. You need to shift from pay-for-volume to capitation at the delivery system (doctors and hospital) level and drive innovation through generative AI. Ultimately, the solution will come through prevention of chronic disease and effective control of the medical conditions when they arise.
Virginia Schmidt, MD. Family Medicine Physician (Chicago): High-quality care requires the right diagnosis and treatment in a timely manner, and I think the doctor is the most important factor in this. Payers affect quality of care when their actions cause delays in care that lead to worse outcomes and less effective treatments.
Brad Sorosky, MD. CEO of Desert Spine and Sports Physicians (Phoenix): The excessive time physicians spend on administrative tasks — particularly prior authorizations — is directly harming patient care. Currently, medical practices spend an average of 14 hours per week just on prior authorizations, costing our healthcare system $35 billion annually. This isn’t just about paperwork — every hour spent navigating complex insurance requirements, submitting multiple authorization attempts and managing appeals is an hour taken away from direct patient care.
Jason Taub, MD. Neurosurgeon at Dallas Neurosurgical and Spine: The need for flexibility in assessing patient needs, as well as the inability to create a uniform formula for all surgical patients.
