Best Practices for Expanding Your Payer Portfolio

In the first two parts of this series, we discussed types of payer models and took a close look at determining the true profit margin of contracts (Read them here). Now it’s time to create a few strategies to market yourself to HME payers and expand your payer portfolio. There are three main factors that you want to focus on to achieve the best results in expanding your payer portfolio. First, you will want to develop your knowledge and educate yourself and your staff on how to build a plan in acquiring contracts with the best possible rates for your business. Second, you will want to market yourself and understand where to focus your efforts. Finally, utilizing a payer network can help you implement strategies to remain profitable by reducing labor costs and providing access to other payer sources.

Knowledge: Building a Plan

To quickly recap the tips and tricks from the first two articles in the series, the first step is to build a plan for your company that makes good business sense. Review each of your existing contracts and determine if they should remain part of your business. Carefully consider the ones that are not profitable but are important to your business. Once you have a list of contracts to keep, consider exiting the rest. Next, examine the payer contracts and determine which payer networks—and which specific contracts—would be profitable. As mentioned in the first article of this series, look outside traditional payers. Diversifying your portfolio will give you access to more people and decrease reliance on less profitable payers.

Marketing: Make Them Want You

Now that you have your wish list of payers, it’s time to market yourself to them. Marketing is more than your logo—it’s how you differentiate yourself from your competitors so that when a payer has a need, you are the first company they think of. Anna McDevitt, CEO, Lab Tactical Consulting, offers the following advice for forming value-based relationships with payers: focus on your strengths, contact the right person in the company and—once a relationship is established—stay engaged. Focus on your strengths. When you want to be chosen as a partner by a payer, emphasize your value. Provide evidence of how your company would make a good partner for this payer. For example, include information on patient satisfaction, how you have remained profitable in the market or examples of patient improvement. It’s who you know. Identify your best contact at the payer level, and ask questions to understand their motivations and challenges as well as how they define success. Then you can align your strengths to their priorities. To find the best contact, first understand how that particular company makes contracting decisions. Then, start asking your representative questions. Though they might not be the best person for your needs, you can work your way through the company to reach the best point of contact. Report back. Once you have established a relationship, schedule meetings with decision makers. Share the data and information that establishes how your company is an asset to theirs. The easier you make their jobs, the better the chances they will think of you first for their needs.

Group Purchasing Organizations: Utilize Resources

Assess what else you need to do for a strong business base. Do you need to reach out to companies who offer a payer network to add additional contracts to whom you may not have access? Do you need to expand your product offering? If a contract on your wish list is not accepting new companies, reach out to a group purchasing organization (GPO) to see if that contract is available through their payer network. You will often be able to access contracts that are closed to independent businesses, and you might be able to access them at more favorable rates than what you could have negotiated on your own. Some GPOs offer access to their payer network at no additional cost to members. If you decide to expand your product offering, take advantage of tools from the GPO that allow you to see what products your physicians are ordering. This will help you to understand their referral patterns and ensure that your sales team is calling on these doctors and asking for all of their business, not just part of it. This is a great way to maximize the value of each call point and patient interaction. It makes no sense for a patient to have three different HMEs providing products to them when your company can do it all. It is also easier for the payer and the referral source to deal with only one HME provider. While this may require you to add additional products to your warehouse, you may find that by providing a variety of products, you are able to receive more business. Utilizing a GPO can also help to reduce costs in labor by relieving the administrative burdens of credentialing required by some, if not all, payers. You will not have to waste countless hours or hire a designated contract negotiator to get favorable rates, acquire or maintain the provisions of these contracts.

Networking: Make the Most of Your Sales Team

Now it’s time to put your sales representatives to work contacting physicians. Your sales team should understand the overall business plan, payer reimbursements and what makes sense for your business. They should not be sent out for the sole purpose of finding business, but instead already have a list of physicians that are referring the products that you want to provide to patients, and a list of insurances that pay at a profitable rate. Your sales team also should be well trained at explaining why you do not provide certain products or why certain providers are missing from your payer portfolio. Everyone in the medical field realizes that the payer landscape has changed, and they most likely will be happy to work with a company that really understands the industry challenges and is working with their patients.

Putting It All Together

Understand that expanding your payer portfolio is an art, not a science. You will not be able to get 100 percent of the referrals you want, and you will not get paid 100 percent of the time at a rate you are happy with. However, having a plan and being informed is half the battle. The other half is implementation. Read other articles in this series here.