During a featured session at Becker's 30th Annual meeting: The Business & Operations of ASCs, Brett Spark, president and cofounder of Aroris Health — a payer contract optimization firm — discussed the complexities of healthcare reimbursement and payer-provider relationships.
He highlighted the recent reimbursement challenges faced by providers and emphasized the importance of leveraging data to build payer trust and improve contract negotiation outcomes.
Four takeaways:
Note: Quotes have been edited for length and clarity.
1. A 'digital footprint' is necessary for successful payer negotiations.
Spark stressed that ASCs should leverage their data and documentation to create a "digital footprint" that's representative of all the organization's payer contracts. This gives ASC leaders full visibility and understanding of the organization's performance under contractual terms, which is crucial for successful negotiations.
"If you don't have a digital footprint for each contract, you can't understand the implications of doing one thing or another and you're probably missing something," Spark said.
2. Time and data are major barriers to success under payer contracts.
According to Spark, most provider organizations struggle to leverage data analytics to support payer negotiations. The time it takes physicians to accurately code in accordance with reimbursement requirements is another barrier. Addressing both of these issues is essential to improve payer contracts — especially for ASCs since these organizations generally have less negotiating power than major health systems. Still, even large health systems need the right data to optimize payer contracts.
"When you're having a conversation with a payer and you're a multi-billion-dollar health system versus an independent practice or a smaller organization, it's obviously different," Spark said. "Still, whether you've got billions or millions in revenue, you're going to miss out on opportunities for improvement if you don't have the right data."
3. Many healthcare providers don't fully understand their payer contracts.
Spark emphasized that ASCs need to have a firm understanding of their payer mix to identify areas for potential reimbursement improvement.
"When we review contract details for our partners, it's amazing how many organizations are getting paid 85% of Medicare for a Medicare Advantage plan and they didn't know that when they signed it.”“Aroris finds and hones in on those opportunities for providers generating an average of 13% in increased revenue.”
4. A data-driven approach can help get past 'no' in payer negotiations.
A comprehensive data analysis of reimbursement and care trends can help providers get around push back at the negotiating table.
“To succeed in negotiations, you must thoroughly analyze your payer contracts and truly understand the data. Rejections are inevitable, but they aren’t roadblocks, they’re opportunities waiting to be uncovered. The key is knowing how to navigate around a ‘no’ and turn it into a strategic advantage,” Spark said.
To learn more about Aroris Health and how it can help you gain leverage in contract negotiations, visit https://www.arorishealth.com/.