Guide

A New Era for Payor/Provider Relations

Combating Distrust in an Industry Myopically Focused on Price

As we turn the calendar to 2019, we survey a very different landscape for payor/provider relations than ever before. Payors prioritize medical loss ratio (MLR) over membership, and there is no single lever for providers to pull that will pressure a health plan into a fair contract.

We believe provider organizations can still get ahead by preparing for payor negotiations in 2019 and beyond. It starts with understanding four key payor/provider trends:

  1. Payor/provider conflict is at an all-time high.

  2. Payors are targeting market-leading “must-have providers.”

  3. Payors’ and providers’ priorities are misaligned.

  4. Payors are positioning at the “top of the funnel.”