Strong Payer Relationships Create Lower Cost, Higher Quality Healthcare

  • Healthcare Management
  • case management - medical management
  • May 13, 2022

Payer relationships are important for ASCs and other specialty hospitals. These relationships mean lower costs for ASCs and more.

Lower Costs And Higher Care Is Possible Through ASCs

With so many chronic diseases and an aging population, managing healthcare continues to be a challenge. Most patients feel the weight of these challenges from a cost standpoint. There’s no secret that healthcare is one of the most expensive necessities in America. Lower cost, higher quality healthcare sounds like a dream. However, ASCs and specialty hospitals have consistently achieved this goal compared to large hospitals. Through strong payer relationships, many of these clinics can thrive.

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The payer-provider relationship

In the past, large hospitals covered most emergency or elective surgical procedures. Then a few decades ago, ambulatory surgical centers and other specialty hospitals were born. These clinics focus on outpatient surgeries or different niches, allowing faster turnaround. Since most patients don’t pay out-of-pocket for services, all medical providers depend on payers. Payers are companies that cover the cost of medical services. A typical example is an insurance company, with the CMS being the largest and most used in the country. Payers and medical providers continually review costs, particularly when new procedures are added.

The importance of solid payer relationships

With limited budgets, payers are incentivized to manage payouts to providers. ASCs are very attractive because of operational efficiencies. In life, everything’s about relationships, and ASCs are no exception. In larger hospitals, payer-provider relationships are often strained due to individual payout disputes and demands. The ASCs and specialty hospitals that can find ways to mitigate disputes have long, fruitful relationships.

Payer relationships pass on to patients

The better the payer relationship, the better the service to patients. ASCs and specialty hospitals provide patients short wait times, advanced technology, reduced infections, and higher success rates. All these benefits happen at a cheaper cost compared to a large hospital.

Access to more services is growing

Better service and lower costs to patients mean better opportunities for specialty hospitals. As a result, more payers are willing to cover different procedures. Joint and spine procedures, for instance, are some of the more recent approvals for ASCs.

How ASCs can develop strong payer relationships

Getting favorable payouts isn’t guaranteed, but some strategies can help. For starters, build a strong case for better payouts. Record and present detailed performance information while showing a competitive advantage. Find out the needs of the payers and find common ground, establishing a collaborative relationship as much as possible. If possible, develop value-based contracts to maximize resources. That way, patients can receive the best care at competitive rates.

Invest in strong payer relationships today

When ASCs and specialty hospitals emphasize establishing excellent payer relationships, everybody wins. Payers can maximize relationships through more efficient enrollment and patient eligibility. Providers can maximize patient outcomes and profitability. Invest in a staff member or external team skilled in negotiating and communicating with payers. This point person or group should seek to understand the needs of payers and how these needs relate to patients. By building the relationship over time, a strong payout relationship is established. The patient wins through lower cost, higher quality care every time.

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