Towards a healthier provider-payer tandem: Messages from IVIg utilization reviews

In the third-party insurance realm, good relationships among patients, providers, and payers are essential. Within this triad, the provider–payer interactions are often dysfunctional. Even in 1798, as the young Union was laying its foundation for prepaid medical insurance, there was cognizance of the potential for misuse of funds.1 Such deep roots lend some credence to prevailing assumptions that providers and payers, while interdependent, are also at odds, each party viewing the other as difficult and unyielding. One author viewed the Medicare payer as an "unrecognized...nonparty" in the provider–payer tandem.2 In contrast, providers consider care oversight and payer's administrative requirements as undue burdens.3 Providers can never stop dealing with diagnostic ambiguity and varying patient wishes, while payers often struggle to satisfy diverse and strident interests to both cover (pay) and control costs. Is there a middle ground with scope for a healthier open-minded dialog among the parties? After all, an important aim of ours is to improve patient care and reduce waste.
Source: Neurology Clinical Practice - Category: Neurology Authors: Tags: All Clinical Neurology, All Neuromuscular Disease, Chronic inflammatory demyelinating polyneuropathy Editorial Source Type: research