Poll of 273 Healthcare Leaders Uncovers Escalating Challenges in Prior Authorization, Data Exchange, and Value-Based Contracting.
NEW YORK CITY, NEW YORK / ACCESS Newswire / May 5, 2025 / A new survey from Black Book Research reveals that deep fractures remain in payer-provider collaboration, with hospitals and health plans struggling to align on core priorities like prior authorization, data exchange, and value-based contracting.
The report, released today, draws on first-quarter responses from 273 executives across the healthcare spectrum, including 225 leaders from health plans, managed care organizations, and payers, and 48 hospital and health system executives overseeing managed care relations and contracting.
Despite widespread agreement that payer-provider collaboration is critical to improving outcomes and reducing waste, the survey exposes three persistent roadblocks and significant differences in how payers and providers rank their urgency.
#1: Prior Authorization Frustration Nears Breaking Point
Hospitals overwhelmingly identified manual, disjointed prior authorization workflows as the top source of administrative burden and care delays:
93% called it a top-two operational obstacle.
88% reported routine delays exceeding five business days.
Only 11% have most of their payer contracts integrated with real-time electronic prior auth tools.
Meanwhile, just 29% of payers say they've implemented electronic prior auth tied to EHRs. And only 17% believe their PA processes are fully aligned with clinical decision-making.
#2: Value-Based Care: A Shared Vision, Divided Execution
"Both payers and providers express commitment to value-based care, but the mechanics are still misaligned," said Doug Brown, Founder of Black Book Research.
84% of hospitals say they lack access to the analytics needed to succeed in VBC arrangements.
75% are in upside-only contracts and say they're ready for more risk-if data sharing improves.
Just 6% of providers consider their current value-based contracts fair or sustainable.
On the payer side, 80% rank VBC execution as a strategic priority. However, only 21% have established joint oversight or governance structures with providers.
#3: Interoperability Still Missing in Action
Years into the digital health push, bi-directional data sharing between payers and providers remains frustratingly inconsistent:
93% of providers say they lack real-time visibility into their patients' utilization outside their system.
82% still rely on faxes, phone calls, and email to communicate with health plans.
Fewer than 1 in 4 hospitals report receiving any form of automated, structured data feeds from payers.
On the other hand, 97% of payers are actively collecting clinical data-but less than a third push that information back to providers in usable form.
"Everyone agrees on the direction-value-based, connected, data-driven care-but we're still fighting over the roadmap," said Brown. "Hospitals want automation, transparency, and real-time data. Payers want control, structure, and sustainability. Until those expectations converge, collaboration will keep stalling."
The study results call for a reset in shared accountability, including: Co-developed performance metrics and risk models in contracts; Interoperable, real-time clinical + claims data sharing frameworks; and Federal and commercial investment in automated prior auth standards.
About Black Book
Black Book Research is a leading independent source of healthcare technology and managed services evaluations. Black Book's crowd-sourced data supports strategic purchasing decisions for providers, payers, and investors across the healthcare continuum without commerical bias or influence. Gratis resources and research reports to industry stakeholders are available at https://www.blackbookmarketresearch.com
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SOURCE: Black Book Research
View the original press release on ACCESS Newswire:
https://www.accessnewswire.com/newsroom/en/healthcare-and-pharmaceutical/payer-provider-collaboration-breakdown-black-book-survey-reveals-crit-1023599