How to Navigate Negotiations and Land a Great Payer Contract

Share: Share on Facebook Share on Twitter Share on LinkedIn

How to Navigate Negotiations and Land a Great Payer Contract

Share: Share on Facebook Share on Twitter Share on LinkedIn
Insurance contract

It can be tempting to put off your managed care contract negotiation responsibilities because working with payers feels like a self-defeating task. After all, insurers are poised to say “no” to every negotiation technique you attempt, and you certainly don’t want to accept the first terms they offer. There are, however, ways to navigate those no’s and come out with contract terms that will allow your practice to prosper.

The next time you’re getting ready to negotiate an insurance contract, use these strategies so you get the results you want.

Develop Your Value Proposition

Before you can negotiate better terms with the payer, you must be able to make a case about why you deserve such terms. This means knowing everything about your organization, identifying what makes you different, and finding a way to articulate that to the insurer.

Pull Together Your Practice’s Vital Stats

It’s up to you to tell the payer who you are, and that means compiling your vital stats—in other words, the features that make you special.

Which services are you providing that other nearby practices aren’t? Do you have diagnostic testing tools or technologies that competitors don’t have? What are your goals for the next one or two years?

In essence, you should have stories prepared that you can share with the payers to demonstrate how your team has improved quality, efficiency, patient access, and patient outcomes. Make sure your stats are memorable and easily repeatable.

Share How You’ve Cut Costs

If your practice has taken steps to reduce costs, that’s the kind of information that will capture attention from payers. For instance, are you referring patients to independent diagnostic radiology providers based on the best value, or are you only referring within your system, where the price is set in stone? The former is likely more appealing to payers, so if you have these types of examples to share with insurers, it will go far with them.

Discuss Your Efficiencies

Being efficient is becoming increasingly important to payers. For instance, suppose you deal with a lot of care transitions, so you call patients while they’re still hospitalized to make sure they have appointments scheduled with you for immediately after they’re discharged. This type of efficiency could cut hospital readmissions and save money, making examples like this very valuable to payers.

Research Insurer Priorities

Prior to negotiating with insurers, do your homework and find out what the payer’s priorities are. For example, suppose the payer has an incentive program to reward practices whose patients present for colonoscopies on time. If you know this is a priority, you should compile your statistics to show them that, say, 90 percent of your patients got their colonoscopy screenings on time last year. Responding to the insurer’s pain points can go a long way in showing your value to them, giving you better negotiating power.

Tell Your Story in Writing

Once you have all of your practice’s positive traits lined up, create a document where you share that information in writing. Even if your payer rep seems very interested in what you have to say, they may not be able to remember it all when talking to colleagues. By giving them a report, they’ll be able to share that internally with colleagues so no matter who you’re negotiating with, they’ll see your value.

Want more tips about negotiating for better-paying insurance contracts? Watch as expert Doral Jacobsen, MBA, provides you with plain-English tips that can help you implement an ironclad negotiation strategy. During her 60-minute online training, “Negotiate Higher-Paying Third-Party Payer Contracts,” Doral will walk you through the steps you must take to maximize your negotiation know-how. Sign up today!

Subscribe to Healthcare Practice Advisor
Get actionable advice to help improve your practice’s
reimbursement, compliance, and success in this weekly eNewsletter.
  • Hidden
  • Hidden
  • Hidden
  • Hidden
  • Hidden