Why Practices Should Leverage Healthcare Data in Payor-Provider Negotiations

Why Practices Should Leverage Healthcare Data in Payor-Provider Negotiations

In 2017, the Economist ran an article proclaiming that data was humanity’s most precious commodity. A quippy version often appears as: “data is the new oil.” Within any industry, having information provides a distinct advantage. Healthcare is no exception. 

When it comes to keeping the lights on, healthcare practices have to leverage their payor contracts—ensuring they’re paid well in a timely manner. However, when negotiating, insurance companies are leveraging their vast swaths of data to do just the opposite. That’s why it’s necessary to bring your own resources to the negotiation table

But what makes data so valuable for healthcare providers? Why should they be leveraging data themselves? 

Healthcare Payer Data Analytics: The Problem

When hashing out the particulars of a payor contract, the payor usually has the upper hand. That’s because they can leverage data and healthcare analytics across all their separate healthcare provider contracts. Simply because they have information you don’t, providers generally are at a disadvantage, and results tend to skew in insurance companies’ favor. 

As a healthcare professional, your primary role is patient health and well-being.

The payor, on the other hand, is strictly a for-profit entity. 

Consequently, these two perspectives will be at odds. Being mindful of their perspective and knowing how they operate better prepares you to negotiate.

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Leveraging Healthcare Data: The Solution 

As a healthcare provider, your occupation is the treatment of your patients and providing value based care, not sourcing patient data and running data analysis. 

To come to negotiations on equal footing, it’s important to leverage internal healthcare data to back up any changes made to your contract. This is typically done in one of two ways. Either you or your employees can take the time to isolate procedures with the lowest ROI and focus on improving these contracts. Or, you can leverage another network of data—a healthcare contract negotiation team to help with the advanced analytics.

At PayrHealth, we focus on researching healthcare payer analytics. That’s our calling. We help to arm you with the same amount of big data insurance companies use so that you can make informed decisions about your payor contracts.

Should you want to have us handle the negotiations as well, we can do that for you.

7 Reasons Why Practices Should Leverage Healthcare Data in Payor-Provider Negotiations

There are seven major reasons why practices should leverage healthcare data in payor-provider negotiations, including:

  • Improving patient care
  • Helping you understand payor contracts
  • Signing better contracts
  • Creating more time in your workflow
  • Controlling more of your own business

Improved Patient Care

In the healthcare industry, data that comes directly from a patient is most important. Payors may not have access to this data, or they might not know how to utilize it properly. To them, your patient is a consumer; to you, your patient is a person who needs care services. On this basis alone, the data will tell a different story between payors and providers. Make sure payors understand your story. 

As an example, consider social determinants of health (SDOH).2 Aspects of SDOH comprise environmental factors, some of which are beyond your patient’s control. Nevertheless, SDOH factors contribute to the quality (or lack thereof) of your patient’s life. SDOHs include (but are not limited to): 

  • Access to clean drinking water
  • Occupational opportunities and education
  • Availability of nutritional food3
  • Affordable housing
  • Technological literacy
  • Location and time of birth

With SDOH data informing your contract negotiations, you will glean how the contract will (or will not) best serve your patients. Furthermore, sharing SDOH data with a payor helps contribute to a whole-person model of care.4

Transparent Data Analytics Helps You Understand Payor Contracts

Payor contracts are drafted by attorneys on behalf of the payor. By virtue of their design, they benefit the payor, rather than the provider or the patient. Their terminology may be frivolously technical. 

Organizations like the Agency For Healthcare Research And Quality maintain All-Payor Claims Databases (APCDs). APCDs5 are sizeable databases that collect and organize data pertaining to:

  • Medical claims
  • Pharmacy claims
  • Dental claims
  • Eligibility files
  • Provider files

APCDs provide uniformity in healthcare reporting as it pertains to payor expenses. In so doing, payor data becomes more transparent and available to providers and to patients. Using this data, you can better discern the legalese of the contract. 

To learn more information about appealing a denied medical claim and denial management, read our blog. 

Sign Better Contracts

Not all contracts are created equal. As contracts will change from payor to payor, each payor will likely change the terms of each contract. PayrHealth’ RevolutionSoftware6 compares and contrasts different payors. We examine and vet the costs of Current Procedural Terminology (CPT) codes. If you’re curious to know how sudden alterations in a payor’s reimbursement schedule might affect your revenue, we can provide that data. 

Properly equipped with this health data, you’ll be able to step to the table with a payor knowing exactly what you need. With PayrHealth leveraging healthcare data, you’ll be able to: 

  • Sign what you want to sign
  • Ask for (and receive) higher rates from the payor
  • Grow your staff as a consequence of higher rates

Create More Time in Your Workflow

Time away from patients is time you aren’t making money. Unfortunately, thanks to the complex legalese within payor contracts, this often mandates hours of reading and translating (for each different payor contract).

By partnering with a contract negotiations provider, they can translate this legalese for you. 

If you’re reading a contract on your own, you may not completely understand the terms. You’re under pressure from different angles. You might be in a hurry and hastily sign a contract that gives the payor all the rewards. 

Once you’re familiar with the contents of a contract, there’s no time to waste. The quicker you decide whether or not to sign a contract, the quicker you can get back to your patients. At PayrHealth, we ensure you’re spending more time tending to patients and less time reading lawyer talk—we’ll handle that part for you. 

Control More of Your Own Business

When payors negotiate contracts with you, they may try to coerce you into signing, knowing that time is often not on your side. Not having data takes away your ability to control the flow of negotiations. 

To start utilizing the data you have, consider using strategic planning tools—like a SWOT analysis7—to define your mission down to the most minute detail. From there, isolate where data can bolster your requests.

Heathcents: Your Healthcare Payer Data Analytics Solution

Today, data is your most precious commodity.1 In a contract negotiation, whoever has the most valuable data sets the terms. As a healthcare provider, how you manage and utilize data shapes the future of your practice. Furthermore, it molds the futures of your patients. 

At PayrHealth, we give you thorough, vetted, well-researched healthcare payer data analytics. With data in your favor, you can: 

  • Provide better care for your patients 
  • Better understand payor contracts
  • Sign better contracts, secure higher pay rates, and hire more team members
  • Free up time in your workflow
  • Control the destiny of your negotiations

Contact us today to learn more. 

Sources: 

  1. The Economist. The world’s most valuable resource is no longer oil, but data. https://www.economist.com/leaders/2017/05/06/the-worlds-most-valuable-resource-is-no-longer-oil-but-data
  2. U.S. Department of Health and Human Services. Social Determinants of Health. https://health.gov/healthypeople/objectives-and-data/social-determinants-health
  3. Food Empowerment Project. Food Deserts. https://foodispower.org/access-health/food-deserts/
  4. Healthcare Finance. Better data sharing between payers, providers can move the needle on social determinants of health.https://www.healthcarefinancenews.com/news/better-data-sharing-between-patients-providers-can-move-needle-social-determinants-health
  5. All-Payer Claims Database Council. The Basics of All-Payer Claims Databases: A Primer For States. http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2014/rwjf409988
  6. PayrHealth. RevolutionSoftware. https://revolutionsw.com/
  7. Journal of oncology practice. Strategic Planning: Why It Makes a Difference, and How to Do It. https://doi.org/10.1200/JOP.0936501
  8. Johns Hopkins Bloomberg School of Public Health. U.S. Health Care Spending Highest Among Developed Countries. https://www.jhsph.edu/news/news-releases/2019/us-health-care-spending-highest-among-developed-countries.html
  9. The New York Times. Major U.S. Health Insurers Report Big Profits, Benefiting From the Pandemic. https://www.nytimes.com/2020/08/05/health/covid-insurance-profits.html
  10. Van Veen et al. Anterior Cingulate Cortex, Conflict Monitoring, and Levels of Processing. https://webapps.pni.princeton.edu/ncc/publications/2001/vanVeenCohenBotvinick2001.pdf