Q&A: Cadie McGonagill on smarter contracting

ALEXANDRIA, Va. - HME providers need to think beyond units and widgets and dig deeper into the terms of the contracts. They also need to nurture their relationships with payers, says Cadie McGonagill, who recently joined AAHomecare as senior director of payer relations. 

McGonagill, who has more than two decades of leadership experience in managed care contracting, reimbursement strategy and payer engagement, most recently at Lincare, spoke with HME News about payer best practices. 

HME News: Will your background working on the provider side in contracting and payer relations serve you well in this new role?  

Cadie McGonagill: Oh absolutely. There's a big need in our industry for understanding how to contract and how to work with payers. We have people just saying, “I got a contract, I look at the price and that's all, and I sign it and then I just throw it in a pile.” There's a lot more to it that we should be looking at and asking questions about. (And we also need) to be able to have a better relationship with our payers. How do we work together? I don't think they know a lot about our industry.  

HME: What do providers need to take into consideration, besides price, when they negotiate contracts? 

McGonagill: I think that's where I see my role going forward, providing a lot of education to our members about what those things should be. What things do you do different in your company? Do you have a high clinical model? Do you provide a particular geography or area of the country or particular brand or product that your competitors don't do? Do you have high customer service satisfaction ratings? On the flipside, when you get that contract, are you looking at all the terms? Do you know what is required of you and if you need to walk away, how do you do that? 

HME: How does a provider know when to walk away? 

McGonagill: That’s really hard. If the reimbursement is unsustainable in the long term. If there’s an unfair administrative burden. It might be service requirements with unrealistic expectations. When you know going into an agreement you’re going to fail, it doesn’t make sense not to speak up on your own behalf. I know we all struggle with saying no because we all need the business, we don’t want to miss out on the opportunity to service that member population. But sometimes, we have to make the hard decisions to make the right decision. 

HME: Beyond just securing the contract, what do providers need to do to manage their relationship with payers? 

McGonagill: I think just reaching out, even on a yearly basis (is important). It’s being persistent and not taking up too much of their time, but maybe once a year you touch base and have that opportunity to talk about things that you do for their members and what you’re doing a little bit differently. It helps all of us for the payers to know what it is we do. 

HME: The industry and its payment models have evolved over the past few years, from fee-for-service to more value-based care. Has that shift been better for both sides of the contract relationship? 

McGonagill: In other segments of health care, they have value-based care down pretty well. I feel like we’re still struggling to find our place. There’s things to be gained by going to value-based care because the objective is to keep the patient well, keep the comorbidities down and keep them compliant. We haven’t developed the 100% right solution for our industry yet, but we’ve got a lot of really innovative thinkers within our space, so I do think we’ll get there.