Payers, It’s Time to Reimagine the Provider Experience

The US healthcare system is shifting. While we have made significant technological advancements and improved the member experience, we must now turn our attention to a vital, often overlooked piece of the puzzle: the provider experience.

For too long, we have been adding to the already high burden placed on providers. Complex prior authorizations, cumbersome claims processes, and a lack of interoperability among systems are barriers to delivering efficient, quality care. They erode provider satisfaction, contribute to burnout, and ultimately impact the very patients we all serve. And the data is telling a stark story: Recent surveys show hospitals are increasingly reporting that their experience with payers is getting worse, not better.

The consequences are significant. According to the American Medical Association (AMA), the vast majority of physicians – more than 80% – say that prior authorization has led to delays in necessary care for their patients, and a staggering 30% say these delays have led to adverse patient events. These aren’t just statistics; these are real people whose health is being impacted by the very systems designed to support their care.

At Cortico-X, we believe that a thriving healthcare ecosystem depends on a collaborative partnership between payers and providers. We must shift beyond the traditional transactional approach and embrace a model built on mutual respect, transparency, and shared goals. An investment by Payers in the provider experience is an investment in the future of healthcare.

So, how do we begin this transformation? Here are a few key areas that will transform the payer-provider relationship:

• Streamlining administrative processes: We need to design systems that reduce the bureaucratic load on providers. This means automating routine tasks, simplifying complex workflows, and providing seamless access to relevant information. This is where AI and intelligent automation come into play, not as replacements, but as augmented intelligence.
• Improving communication and transparency: Providers need clear, timely access to information. We must improve communication channels, provide transparent payment policies, and offer real-time insights into patient data (while adhering to strict privacy regulations, of course). A collaborative platform where payers and providers can seamlessly exchange information is ideal.
• Fostering collaboration and partnership: We need to move beyond transactional relationships and build genuine partnerships with providers. This means actively seeking their input, understanding their challenges, and working together to develop solutions that benefit everyone. Let’s create forums for dialogue, encourage shared decision-making, and re-build trust.
• Investing in human-centered technology: Technology should augment the role providers play, not replace them. Systems must be intuitive and easy to use, which requires focusing on user experience. And the technologies themselves should deliver value, like interoperable EHR systems, user-friendly portals, and innovative solutions like telehealth remote patient monitoring. And, of course, leading payers should consider agentic AI systems to automate or perform tasks on behalf of the provider.
• Align on value-based care: The shift to value-based care requires a fundamental change in how payers interact with providers. We need to align incentives, share data, and collaborate on care management programs to improve patient access and outcomes and reduce costs.

This initiative is not merely a symbolic or feel-good effort; it is a strategic necessity, essential for driving meaningful business outcomes and long-term success. By prioritizing the provider experience, payers can enhance patient care, strengthen provider networks, accelerate the shift to value based care, reduce negative reputational risks, and ultimately create a more sustainable healthcare system. At Cortico-X, we’re committed to partnering with you on this journey. Let’s work together to reimagine the provider experience and build a brighter future for healthcare. We invite you to reach out and explore how we can collaborate to make this vision a reality.

Looking to take your Provider Experience to the next level? Let’s talk. At Cortico-X we specialize in experience led transformation of the healthcare system. If you find this content interesting, please follow Cortico-X on LinkedIn for more insights on the future of experience and healthcare.