The Department of Justice has sued both OhioHealth and NewYork-Presbyterian Hospital this year, alleging that they use contracting tactics that limit competition and keep healthcare prices high. The cases mark a broader push by regulators to scrutinize how health systems use “all-or-nothing” contracts to shape insurance networks and patient access.
The contract negotiation process between providers and payers is now more complex than ever, according to Baptist Health CEO Michael Mayo. In an interview, he spoke about his health system’s recent protracted negotiation with Florida Blue — which required months of preparation, external consultants, and even a task force of board members.
Zelis highlights how employers, payers, and consumers are integrating digital tools to manage healthcare costs.
The healthcare industry stands to benefit greatly from stronger payer and provider partnerships. As the industry works to tear down the barriers that currently exist to bringing these stakeholders together, there are mutually beneficial opportunities that should be considered now.
As margins at health systems continue to contract, and insurance company profits continue to surge, contract negotiations are becoming increasingly contentious. With billions of dollars potentially at stake, you need to be prepared and aligned well in advance.
Given that providers are under increased pressure from CMS to take on some form of downside risk by 2025, they and health plans can utilize these four strategies to make the transition smoother.
Health plans have already begun their triple aim journey down the path of VBC, but often they are building this initiative on an infrastructure that lacks the needed scale, transparency and efficiency.
By reducing administrative burden and redesigning workflows around human needs, it creates space for what matters most: connection between clinicians and patients.