Healthcare continues to feel pressure: financially, operationally, politically, and culturally. Patients are more frustrated than ever with the cost of care and confusing billing practices. Clinicians are stretched to their limits with ever-increasing responsibilities. Payers are on the defense to justify their decisions.
Trust has frayed between all parties.
One particularly dark spot is the relationship between providers and payers. For too long, we’ve considered friction as just a standard part of the industry. But too many aspects of that relationship have gone beyond friction, impacting patients, care teams, and payer operations. From prior authorization requests to post-adjudication recoupments, each interaction carries the potential for inefficiency, delay, or frustration.
And when that friction disrupts workflows, it delays decisions, raises costs, and erodes trust. Then it becomes more consequential: It becomes abrasion.
Tolerance for this abrasion is gone. It wastes time, drains staff capacity, drives up costs, and affects the patient experience.
Understanding abrasion
To address abrasion head on, we must first understand which administrative domains are the biggest pain points.
Both payers and providers believe prior authorization, denials, and payment integrity are major abrasion points. Neither payers nor providers intend to sabotage the other. But it is also clear that they don’t trust each other’s intent. Trust between the two is thin and, we believe, the root cause of so much abrasion. Payers think providers are trying to game the system; providers think payers are trying to withhold care. We have to dig deeper.
So much is at stake if we don’t reduce abrasion – the patient experience, provider experience, and payer operations.
Addressing abrasion together
Payers and providers must collaborate; from the moment a claim is started – even before the patient enters the facility to the moment it’s adjudicated. We must build more transparency into the system, so that providers have a clear view into changing payer policies, and payers have a clear view into claims issues before they even enter the payer ecosystem.
We need to enable access to a central network so that more payers and providers are instantly connected, and, where possible, standardize the claim submission process. And we must focus on smart automation, meaning we should automate routine tasks but allow teams of experts — and AI — to spot patterns in claim denials and work to change what’s not working.
We don’t get there overnight. Leaders must come together to transform abrasive processes into opportunities for efficiency, alignment, and most importantly, better patient experiences. Think of it as a call to build trust by holding each other accountable and monitoring progress together.
Photo: marchmeena29, Getty Images
Russ Thomas, JD is the Chief Executive Officer of Availity, the nation’s largest health information network connecting over 3.5 million providers to more than 95% of U.S. health plans and 17,000 technology partners, facilitating over $4 trillion in healthcare transactions annually. At this scale, Availity plays a central role as the backbone of modern healthcare to transform the most complex friction points between payers and providers into opportunities for collaboration.
In his role, Thomas brings nearly three decades of experience in healthcare technology, digital transformation, and cross-stakeholder collaboration to advance administrative simplification, real-time data analytics, and system-wide accountability that reduces provider burden and improves patient access to care. In addition to his role at Availity, Thomas currently serves as Chair of the Florida Chamber of Commerce Healthcare Policy Council, and on multiple healthcare and philanthropic boards. In addition, Russ is a commercial rated pilot who served on the Jacksonville Aviation Authority from 2015 to 2022.
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