As more pricing information becomes available, organizations should rethink contracts, negotiation strategies and analyze data to understand their competitive performance. From payers’ perspective, they would begin to scrutinize that data, service by service, region by region, to develop arguments against paying high-cost healthcare providers much higher rates than others.
The price transparency rule and No Surprise Bill Act will change the dynamics of negotiations by giving payers, providers, employers, and pharmaceutical companies more data. With more information available, participants will have the opportunity to work on better deals, review their quality standards vs their costs range and obtain better arguments for negotiation purposes.
Considerations for new contracts’ negotiating strategies:
- Providers and payers may look to take advantage of new available information, seeking at their competitor’s deals.
- Payers may look to drive down their rates with high-cost providers or negotiate with out-of-network providers to become in network participants and make deals for lower rates.
- Hospitals and other providers should use data-analysis solutions to make sure they are being paid fairly in the marketplace.
- Providers with lower rates could use data points on competitors’ rates to elaborate an argument for increasing their reimbursements.
- Providers with high rates should work on patient’s experience strategies and improve their quality standards so they can justify their prices.
Overall, both hospitals/providers and insurers will have to understand the new rules implications and move quickly to emerge as key partners to successfully respond to new regulations and enhance their consumer experience and relationship.
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