By Ryan Kline
In the next year we’ll see a provider terminate a carrier network contract without losing a single patient. They’ll realize that the cost of doing business with the carrier no longer justifies the volume.
Rather than wasting resources negotiating, they’ll talk to every self-insured CEO and CFO in their market that uses that carrier’s network. They’ll develop a home-grown plan for fully insured companies and individuals. Patients will just move from one contract to another contract overnight and the carrier will be displaced.
The providers ready to execute on this strategy already have detailed margin calculations, broken down by payer and by network product:
-Paid-to-expected ratios
-Patient responsibility not collected within 90 days
-Days in A/R
-Fully-burdened RCM expense
-Clawbacks
From there they will divvy up the savings and create contracts with lower costs for the employer, lower costs for the patient, and higher yields for the providers.
Providers already have all of the tools at their disposal. They need to be in rooms with the pillar employers in their communities now, laying the groundwork for the next renewal cycle.
Carriers have blamed providers for the cost increases for decades, and this is all that employers have heard from their brokers and consultants. The only way to challenge that narrative is to be completely transparent: here’s what I’m dealing with today, here’s how you can reduce my costs, here’s how much I can give you back for doing that. Rebuild on a foundation of trust.
These conversations are happening now in boardrooms across the country. Many employers have run out of options for keeping their teams healthy. Which providers will be the first to show them a new way of working?
