During a featured session at Becker's 21st Annual Spine, Orthopedic and Pain Management-Driven ASC +The Future of Spine Conference, Brett Spark, president of Aroris Health, discussed challenges and opportunities in payer contracting for ASCs.
He emphasized the importance of leveraging internal data to assemble performance insights. He also highlighted the importance of understanding the dynamics of each individual payer agreement. Mr. Spark suggested that digitizing these agreements could uncover opportunities for increased revenue without the need for negotiation. He also discussed current fee-for-service models and the future of value-based care.
Notes: Quotes have been edited for length and clarity.
Here are four takeaways from the session:
1: Understanding the practices of each individual payer is crucial for successful contract negotiations.
A firm understanding of how each payer reimburses for different procedures and services can help ASCs identify areas for internal performance improvement and where there might be existing opportunities to negotiate for better reimbursement rates. According to Mr. Spark, Medicare Advantage contracts are often prime targets for renegotiation.
"We've negotiated more Medicare Advantage plans this year than I ever have or ever thought I would in my career. We had a client that was receiving 70% of what Medicare would pay for their Medicare advantage plan. They had no idea that they had signed off on that deal, and that's the lowest I've seen. So, understanding the payer data and behavior is essential, not just for one payer but for all the payers your ASC is working with." - Brett Spark
2: Analyzing your own claims data is essential for negotiating better contracts.
By analyzing internal claims data, ASC leaders can identify trends, volumes, and reimbursement changes from payers. This information is vital for understanding the financial impact of contract negotiations.
"Your own claims data is the link between you and the payer... That information is vital to understanding reimbursement changes from the payer side and identifying allowable rates that you didn't know about." - Brett Spark
3: Digitizing payer contracts can uncover hidden opportunities for negotiation.
By digitizing payer contracts and organizing the information in a digital format, healthcare organizations can pinpoint areas where they can negotiate for better reimbursement rates. This process allows for a comprehensive analysis of the agreement and reveals potential opportunities for improvement.
"Breaking down the 60-page agreement that you have with each one of your payers and pulling out the things that drive revenue and getting that into a digital format will uncover opportunity without even having to negotiate." - Brett Spark
4: Leverage the unknown within the data to drive profitability.
By harnessing the available data and gaining insights into reimbursement rates, healthcare organizations can negotiate for better contracts that directly impact their bottom line. It is important to understand the dynamics of each payer and apply pressure to achieve favorable outcomes.
"Harness the unknown within the data. It takes time and resources to get to it but, once you find it, you can find new opportunities to drive revenue." - Brett Spark