Episode Overview
Health care providers are in one of the most challenging times with payer contract negotiations. There are new economic pressures, changes in reimbursement structures due to shifts in site-of-care, and payers wanting providers to assume more risk. On this episode of Value-Based Care Insights, host Daniel J. Marino and Cliff Frank, a national expert in managed care contracting, discuss how health care providers must move forward and successfully perform under risk-based contracts.
Key takeaways:
-
The COVID-19 pandemic created a large shift in the site-of-care from the inpatient to the outpatient setting. This caused payers to make changes to their reimbursement structure.
-
Reimbursement pressures are tremendous right now, with payers making frequent adjustments to policies and denying claims that previously would have been approved. This creates additional friction costs for providers, who are working hard to keep up with the shifting landscape.
-
Payers want providers to assume more risk, and in order for a provider to do so, they need to be able to contain and even reduce costs. If providers are going to enter into risk-based contracts, they have to reduce their cost structure internally and reduce friction costs with payers.
