STRATEGIESTO CHANGEPAYERBEHAVIOR Exploring Successful Strategies To ChangePayer Behavior

While many hospitals are operating in negative margins, payers are bringing in record revenues and profit margins. And healthcare organizations have fallen into a pattern of not fighting or simply accepting many denials, much to their financial detriment

At Becker?sHospital Review?s2023 Annual Meeting, in a workshop sponsored by CorroHealth, Jay Ahlmer, president of Corro Clinical, and Jerilyn Morrissey, MD, chief medical officer for CorroHealth, shared insights and tactics into how to change payer behaviors to help hospitals and healthcare systems better recoup money

Three key takeaways were:

1. Payers are doing everything they can to increase profit margins, even as hospitals struggle Payers?financial performance has continued to improve year after year Meanwhile, provider organizations are struggling financially, and each year have to work harder to achieve the same level of reimbursement as the year before, particularly for Medicare Advantage programs

With large marketing budgets, payers are focused on capturing market share by signing on new members and are working to improve revenue per member Payers invoke terms and initiatives such as ?frictionless healthcare?and ?frictionless billing.?

Being ?frictionless?may sound great, but it is code for increasing margins by lowering administrative and medical costs, in some instances creating disadvantages for providers. ?When payers think of frictionless healthcare, they think of ways to get to the end result, which is maximizing their profit margin with a lot less hassle,?Dr. Morrissey said. ?In many ways, the payer and provider relationship is a zero-sum game,?Mr. Ahlmer said. ?A substantial amount of the payer?s profits come from limiting their payments for hospital services ?

2 To change the status quo, provider organizations must learn to influence payers to change their behaviors ?Hospitals don? t have to simply accept the role of victim in payers? pursuit of ever increasing profits. There are strategies and tactics that can be deployed to establish new expectations and boundaries with payers to create a more sustainable partnership,?Mr Ahlmer said