Finding the “Backdoor” into Payer Networks

By Steve Selbst bio  I am delighted to be able to share with you a key “secret to success” about payer contracting. Today’s article is about getting in the “backdoor” with payers and complementing your payer network by building your patient/customer base. In my journey navigating tens of thousands of payer contracts’ negotiations, it has become clear to me that there are times when a payer will close its network to certain provider types, based on its network need. Don’t despair; there are other “paths to Oz.”  Certainly, there are ways to build value propositions and ways to escalate up the payer management chain. These are topics for another day. Today, we’ll talk about an even easier to implement alternative: complementary payers! Complementary payers What is a complementary payer? Looking at the triangle/ diagram at the bottom, we see there are Complementary Primary Payers (middle layer) and Complementary Secondary Payers (bottom layer). Further, there are insurers in the middle layer and re-pricers. Let’s do a deeper dive. When you get stuck and find that you cannot get into a payer’s network, you can pursue a combination of primary complementary payer and secondary complementary payer agreements. The re-pricer (primary complementary payer) […]