Payer relations: Speak their language

Q. How do I use data to successfully negotiate with payers?

A. Let’s be honest, walking into a payer negotiation without data is like showing up to a job interview without a resume. You need to tell your story with numbers.

Start with what makes you different. Do you reduce re-hospitalizations? Get patients set up faster? Have above industry compliance rates? Quantify it. Payers respond to cost avoidance and member satisfaction, so speak their language.

Bring market benchmarks to the table. Use Transparency in Coverage data, utilization trends and rate comparisons. If Medicare Advantage plan reimbursement from CMS has increased but your contract hasn’t kept pace, that’s a conversation worth having. The KFF data on MA payment increases year over year is a useful starting point.

Be fluent on your top codes. What are the 15-20 HCPCS that represent a large percentage of your revenue? If certain codes are margin-negative, push to carve them out or hardcode a different rate.

Incorporate solutions to reduce administrative burdens that could save resources such as waiving prior authorization. Propose alternative payment structures to be margin-positive but keep it simple for both parties to manage.

Don’t forget operational costs. Products, fuel, shipping, staffing – bring real numbers. Miles driven per year. Shipping cost increases versus shipment volume. Product cost percentage increases year over year. Our industry can’t pass these costs to patients, so the payer needs to understand the pressure you’re under. AAHomecare’s infographics containing survey data can back you up here.

Finally, come ready to collaborate. Share your data, co-develop care models, and propose reimbursement structures that work for both sides. Payers want partners, not just vendors.

The bottom line: Your value is real. Make sure the data proves it.

Cadie McGonagill is senior director of payer relations for AAHomecare.