Payer-Provider Relationships: 3 Key Strategies

A few trends affecting payer contracts can't really be resolved with better organization, but should be kept in mind:

• Go beyond the current language.

Jorgensen recommends scrutinizing contract language for opportunities to take more procedures in-house, boosting reimbursements.

"Often you can do diagnostic tests in the office cheaper than the local hospital can do," he says. "You have to think out of the box for revenue opportunities" that can arise in the relationship.

• Remember the human touch.

Childs and other consultants stress how important it is to maintain a relationship with insurance company representatives. "You want them to be familiar with you ahead of time and respond when you have to call with a concern," she says. This isn't always easy, they say, so be prepared to try more than once to reach out.

"I'm encouraging practices to set up lunches with provider reps," says Tinsley. "Get them talking about how they are creating value-based reimbursement models and let them know you want to be an early adopter."

Milburn suggests making one person in the practice responsible for identifying new value-based performance programs among your payers and making sure they get added to your contracts.

"This is going to represent a bigger piece of total compensation every year going forward," he says. "Start tracking them so you can go to individual providers and give them incentives" to participate, he says.

• If you can't beat 'em …

Face it: Specialty groups are getting bigger and aligning with hospitals and other groups for a reason, and a lot of it has to do with boosting clout among payers.

"My advice is in this day and age is, 'Size does matter,'" says Richard Bailey, an internist and chief medical officer at Riverview Hospital Association in Wisconsin Rapids, Wis. "Be proactive and don't put your head in the sand on this one."