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Look at Payer Relations from a Different Mindset


Physicians often look at their relationship with payers through an us vs. them mindset. That's the wrong tract to take says one doc.

Payer relations - have they've always been bad or at least appeared to be bad? Or rather, could it be how we view the relationship? Will they get better or worse in 2017? I don't know the answer to that last question, but I suspect your perception of the relationship is going to be key.

Perception is Key

When I begin coaching a client, there are some fundamental questions I ask to get an idea of how they perceive the value they bring. One of my very first questions is, "How do you see yourself?" I'll ask follow-up questions to dig for their perception of their self-worth. I want to know how they view and value the services they offer. What is the value they place on treating the patient? Sometimes it's right; sometimes it isn't. The goal is to get them to verbalize their value. Once you've established the value you offer, then you're in a much better negotiating position.

The next area I focus on is payer relations. How do you view your position in the relationship? How do you see them? How do you think they see you? I want to see what their level of need is. What is the mindset of the physician, is it a fixed or growth mindset?

A mindset is the way you think and feel about any particular person, place, or event. A fixed mindset believes the world, a person's potential and abilities, and the pie is fixed. In doing so, that person has only one option, and this is to focus on their own needs. If you walk into an event with a fixed mindset, one that sees the situation as you versus them - for you to win, they must lose. A growth mindset holds that everyone has potential and every situation has the potential to improve. It's not an optimistic worldview, but one that holds things have the potential to improve whether they do improve or not. A growth mindset also allows you to focus on the needs of the other party instead of your own because you see the pie with the potential to grow. This particular way of thinking is key when it comes to any relationship.

Have you ever asked, "What do they, the payers, need?" Have you ever wondered why payers exist? They have contracted with companies and individuals to facilitate access to healthcare providers. They sold a contract or promise to their customers. "We have excellent doctors that can help take care of your employees, families, or yourself." They need those patients to be taken care of. If doctors no longer agree to see their patients, they have a challenging time keeping their promise they made to the people who bought their insurance contract. They need for a physician to see their patients. Your job to meet that need. That's the value you offer. Yes, you should offer high-quality care to your patients. But that's only part of it when you are dealing with payers. They do pay for quality, but they also need access.

The next time you sit down with a payer, remember that you are there to help them keep their promises to their enrollees. That's how you're helping them. Ask questions that help frame that need in their mind. People in need are more apt to comply with requests than those who are feeling threatened and forced. Keep a growth mindset and keep in mind they have promises they must keep to the patient as well - you're just helping them keep those promises.

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