Navigating the Complexities of Payor Contracts: Expert Insights

The world of payor contracts has become increasingly complex, with changes happening at an unprecedented rate. Private practice physicians are facing new challenges in managing these agreements, which can have a significant impact on their businesses. In this article, we'll explore the latest trends and expert insights to help you navigate the complexities of payor contracting.

The Impact of Consolidation

Consolidation among insurance companies, hospitals, and other healthcare entities has led to significant changes in the payor landscape. Dr. Zuhdi Jasser, head of the Jasser Center for Comprehensive Care in Phoenix, notes that 'there's a lot changing around us, and there are headwinds to that change.' This consolidation has resulted in longer feedback loops, with payors taking 12 to 18 months to respond to changes or concerns.

The Importance of Building Relationships

To manage value-based contracts successfully, private practice physicians must build better relationships with their payors. Dr. Karen L. Shah, a shareholder at the Polsinelli law firm in Chicago, emphasizes the importance of developing connections and resources within your organization. 'If you can develop those connections and resources, value-based contracts can be managed – just not easily,' she notes.

The Role of Data-Gathering

Data-gathering is another crucial aspect of managing payor contracts. Dr. M. Smith, owner of a private family practice in Raeford, North Carolina, believes that 'practices should work to build better relationships with their payors, participate in better data-gathering, and learn the ins and outs of value metrics.' This requires a deep understanding of the health-plan payment landscape and how it affects your practice.

Expert Resources

For private practice physicians looking for guidance on payor contracting, the American Medical Association (AMA) offers several valuable resources. The AMA's Private Practice Physicians Section (AMA-PPPS) has developed a toolkit on payor contracting that covers key elements such as contract language and unilateral policy changes. Additionally, the AMA offers free webinars, including 'Payor Contracting 101' and 'Payor Contracting 201,' which provide expert guidance on navigating the complexities of value-based contracts.

Navigating the complexities of payor contracts requires a deep understanding of the latest trends and expert insights. By building better relationships with payors, participating in data-gathering, and learning about value metrics, private practice physicians can successfully manage their agreements and optimize their revenue streams. Whether you're a seasoned practitioner or just starting out, it's essential to stay informed and adapt to the changing landscape of payor contracting.

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