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Strategies to Get the Most from Payer Negotiations

Strategies to Get the Most from Payer Negotiations

In the changing landscape of small practice management, payer negotiations definitely deserve the emphasis they are getting as a way to help small practices navigate forthcoming industry changes such as ICD-10 and the shift to outcome-based payment models. Payer negotiations are an opportunity to turn the tables on that feeling that your practice is at the mercy of myriad industry forces. It's not.

Make the investment in preparation for payer negotiations. Think about it as an opportunity for your practice data to tell a story that you can use in your negotiations and that demonstrates how your years of hard work improving patient health are advantageous to the payer. Payer negotiations can help your business prosper in spite of industry changes.

Know Thy Practice: The Value of Data

Every practice has its unique characteristics and strengths. Payer negotiations that seem overwhelming are, in fact, a chance to articulate these aspects of your business. Statistics show that private practices that present data during payer negotiations could be awarded contract terms between 3 percent to 10 percent higher than those who don't present data, according to Medical Economics. When preparing, keep in mind all the ways the health plan has benefited from your quality care to their members.

Make payers aware of any outstanding quality metrics and patient satisfaction scores you have. Assemble comparative data about your practice as compared to others in your area and/or specialty. What makes you stand out? Third-party billing services are sometimes a great source for various benchmarking information related to your specialty and payers. Some of the major industry trade and specialty associations also offer comparative metrics that can be useful in understanding and positioning your practice. Even payers keep and maintain scorecard data on healthcare providers and are happy to share that information. Any health plan that's serious will make at least its qualitative data available. Bottom line, if you can demonstrate your quality of care actually prevented hospital admissions, readmissions, or unnecessary procedures, negotiating favorable terms will come more easily.

Inevitably, gathering all this data will also help you create a clear picture of your practice and a strategy to improve your position with each payer. These are good things to have in your back pocket when the negotiations turn to, "What can you do for us?" Having the ability to provide qualitative metrics such as HEDIS and meaningful use measures may swing the negotiations in your favor as well. For example, being able to exhibit your diabetic patient population's A1C levels may allow you to squeeze out incentives or bonuses based on your results.


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