Quick look: 5 payer contracting best practices

Today payer contracts carry more weight than they ever have. But negotiating them can be a complex and challenging process. Here are a few tips to effectively negotiate and manage better contracts for your organization.

Know your costs

Before entering into a payer contract, clearly understand your costs for providing each service or treatment your organization offers. It can help you negotiate fair reimbursement rates and avoid underpayment or overpayment. 

Define key performance indicators (KPIs)

Define these KPIs for each contract that aligns with your strategic goals and focus on care. KPIs should be measurable, specific, and achievable and should incentivize providers to achieve better outcomes and lower costs.

Consider risk sharing

Risk-sharing arrangements, such as shared savings or shared risk contracts, can help align incentives between healthcare organizations and payers and encourage collaboration on cost reduction and quality improvement initiatives.

Use data and analytics

Leverage data and analytics to inform your negotiation strategies and track your performance against KPIs. It can help you identify areas for improvement and negotiate better contracts in the future.

Collaborate with payers

Create open lines of communication and build trust with payers. Healthcare organizations and payers can achieve better outcomes and lower costs by working together to address common challenges and goals. 

Successful organizations use Medallion

For comprehensive information on this topic, read: What is payer contracting?

Only Medallion is designed to run your provider operations process from top to bottom, giving your team more room to transform patient care experiences. Sign up for a free 30-minute demo today to discover why brands like Hims, Teladoc Health and Ginger trust Medallion to handle their provider operations.