Healthcare Strategic Growth Blog

When entering payer/provider reimbursement negotiations, the need for data to back your position is critical. The right insights can show how your payer contracts compare to the market, how payer rates have changed over time from facility to facility, and highlight financial opportunity. This intelligence can equip you to more successfully navigate payer negotiations and leave with more favorable reimbursement rates.

The infographic below highlights a particularly helpful data-based insight called Fair Market Reimbursement. This is a reasonable range of reimbursement rates that all providers within a local market receive from a commercial insurer or payer. Created by our partner Ancore Health, the infographic below explains Fair Market Reimbursement in more detail, by answering several common questions.  

Key Opportunities Hospitals Leaders Shouldn’t Overlook

By Morgan Atkins

The trials of 2020 have left many in the healthcare industry searching for ways to diversify their income. Due to COVID-19, hospitals across the nation are estimated to lose $200 billion between March 1 and June 30, according to a report from the American Hospital Association. This current financial strain and shaky future prospects are pushing healthcare institutions to find creative ways to keep revenue flowing while still maintaining high-quality care.

Becker’s Hospital Review cites the reimbursement landscape challenges and dwindling patient volumes as two main factors leading at least 29 hospitals across the U.S. to file for bankruptcy this year. In this post, we’ll consider how hospital leaders can turn these leading indicators of distress into golden opportunities for growth.

Level the Playing Field for More Productive Negotiations

By Jennifer Keller

There’s a discussion across healthcare about the need for greater price transparency. The talk is about whether or not patients should know the hard costs of medical procedures and how much they can expect to pay out of pocket for medical services. Armed with this information, they can shop around for care that fits their quality standards as well as their budget. 

At Stratasan, we feel there’s another layer of healthcare price transparency that’s needed—transparency that can level the playing field in provider-payer reimbursement negotiations. Both providers and payers are in need of more data to inform their negotiating position.

Leverage Adjustable Confidence Scoring for Empowered Payer Negotiations

By Hannah Killian and James Porter

In survey research¹, a confidence level is applied to express how confident a researcher is in the data obtained from a population sample. A confidence level lets someone know if they can trust the research data to make decisions. 

Similarly, a confidence level (or score), when applied to all-payer claims data (APCD), indicates the trustworthiness of this data for making healthcare decisions. It’s a metric that ensures integrity and can empower a provider to use this data with greater assurance. 

Greater data confidence can be useful when pursuing a number of healthcare planning initiatives. In this post, we’ll discuss specifically how an adjustable confidence-scoring system is valuable when preparing for provider-payer reimbursement negotiations. Equipped with this tool, providers can:

1. Experience data with certainty, knowing that the cleaning and curation work has already been done 
2. Apply their intuition, since variability can be adjusted to allow for the application of local knowledge
3. Approach negotiations empowered by data insights, assured that the data they’re relying upon to make decisions is trustworthy

Let's get started discussing each of these factors in more detail. 

Tips for Shifting to a More Aggressive Virtual Care Growth Strategy

By Brian C. Young and Lee Ann Lambdin

Hospitals and caregivers across our country are pivoting in response to COVID-19. While the impact on individual hospitals varies greatly, a common theme for all providers is the need to keep patients at home, whenever possible, for the safety of both patients and providers. This has opened the door for telehealth growth and we’re witnessing a rapid shift from a previously deliberate adoption path to a record pace of uptake. 

“Telehealth is bridging the gap between people, physicians, and health systems, enabling everyone, especially symptomatic patients, to stay at home and communicate with physicians through virtual channels, helping to reduce the spread of the virus to mass populations and the medical staff on the frontlines,” said Dedi Gilad, CEO, and co-founder of Tyto Care, a telehealth technology company, in this Healthcare IT News article. 

So what is the future for telehealth, after the current “stay home” mandates are lifted? How can hospital planners prepare for a change in strategy in light of our collective embrace of virtual technologies?