Jerry Tillinger, CEO of US Digestive Health, joined Becker' to discuss his key tips for maintaining good relationships with payers.
Editor's note: This interview was edited lightly for clarity and length.
Question: What payer behavior is concerning you in the GI industry currently?
Jerry Tillinger: The payers are working on their bottom line, just like every other business. They're looking for opportunities to reduce cost all the way around, even while they're increasing premiums. That's a continued dynamic with the payers. We've got long-term, stable relationships with our commercial payers. We do occasionally go into negotiation cycles that can be a little chippy as we advocate for our patients’ access and proper reimbursement, and the payors advocate for keeping costs down. We have been very successful in reaching good agreements with our commercial payers over the last five years, and that's been a pretty consistent story for the group.
Q: What's your strategy for maintaining successful payer contracts?
JT: Payer relations is one of the most important tasks in practice management. The first step in any payer negotiation is to make sure that you are truly prepared for the demands of the negotiation process. You need to have your quality, cost and service data ready and organized to advocate for your providers. You need to know what contract outcome is acceptable for your practice to succeed. You need to be prepared for the patient communication process if there's a possibility you'll go out of network. The operations team needs to be ready for every possible outcome. You need to be prepared for those items so that you can represent your organization with confidence.
The payers want strong providers in the community, and if you get them in moments of candor, they want independent practices. They don't want hospital-owned practices to be the dominant force in the market — they understand how that generally means a rise in cost. Independent GI practices do a great job of providing a high-quality service at a very reasonable cost in the market. With that said, they're still insurance companies. They will still do everything they can to keep costs low, and so you need to be prepared. Discussions with your large payers are some of the most important things you do. You can't treat it as an afterthought and not be ready to have good communication with them and your patients around the process.