At its core, payer contracting refers to the agreements between healthcare organizations and payer organizations that dictate the terms and conditions for medical services, coverage, and payment.
Outdated technology and infrastructure also pose significant barriers to innovation. A Healthcare Information and Management Systems Society study found that 50% of health plans cite legacy technology and infrastructure as a barrier to innovation.
Additionally, efficient payer contracting can lead to cost savings and improved quality of care, demonstrating the importance of payer contracting and its potential financial impact on healthcare organizations.
1. The first is establishing clear goals and objectives for the contracting process, including a detailed understanding of the organization's financial and operational needs.
2. It is also critical to develop a robust network of providers that meet the organization's standards for quality of care and cost-effectiveness.
3. Another critical step is to communicate regularly and negotiate with payers, leveraging data-driven insights to support contract negotiations and ensure that reimbursement rates are commensurate with the quality of care provided.
Payer contracting is without a doubt a very complex and time-consuming process that requires a high degree of expertise and specialized knowledge. Every healthcare organization is different but it boils down to two options: you can handle the process in-house or work with a third-party company.