Tension at the Payer-Provider Interface

The tension at the payer-provider interface is currently heightened due to lawsuits, contract negotiations breaking down, and financial pressure post-pandemic. This cyclic tension is exacerbated by new regulatory changes that can be helpful to one party while harming the other. The lack of transparency in the system adds to the tension, with payers holding the financial power and information. Transitioning into a managed care environment causes additional tension as payments are significantly lower than fee-for-service, leading to financial losses for providers. This tension is further intensified when unexpected expenses, like increased hospitalizations, impact managed care organizations financially.