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Three Habits Providers Should Break in 2021

Nate Kaufman's 2021 New Years’ resolutions show that the stakes have never been higher for hospitals and health systems. We sat down and discussed these topics more in-depth with Nate back in September on our last Operation Recovery episode.

One lesson from 2020 that Nate points out should not come as a surprise to any hospital or health system that has faced or is prepping for a contract negotiation: payors are only getting more aggressive, and health systems need to be ready to play hardball.

When the pandemic hit, providers thought this would finally be the time payors would step up and lend a hand, but we all know this is far from what happened. During the pandemic, payors have been pushing unsustainable proposals on health systems all while significantly increasing claims denials, processing delays, and administrative burdens on providers. 

So, what can hospitals and health systems do to strengthen their position for their contract negotiations in 2021? As Nate says, it’s not enough to rely on mission alone to back up our asks during payor negotiations. Here are 3 habits providers should break in 2021: 

  1. Shying away from using data in public negotiations. Providers are hesitant to talk about the specific terms in their contract, but there are plenty of other data points to help us make our case, such as the amount owed in denied claims, the average delay in payment, the number of covered lives, and their COVID-19 financial story. Sharing this data publicly will reinforce your ask and strengthen your organization’s story during negotiations. 
  2. Believing that payors share your organization’s same values. Providers are driven by their relationships with their patients and the community they serve, while payors are driven by increasing their bottom line. Payors are not worried about patients’ continuum of care, which makes them unphased by network disruption. That’s why it is important for providers to be prepared to face an out-of-network situation, no matter how confident we are that a deal will be reached. 
  3. Hesitation to publicly acknowledge a potential out of network situation. We can’t hope negotiations will resolve on their own and can talk about the issue without attacking the payor. We must embrace creating uncertainty in the market for payors to take our ask seriously. 

Need help getting your new resolutions on track for upcoming negotiations? We’re here to help! 

January 15, 2021
Nothing beats a good old-fashioned conversation.
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