Given the pace of payer mergers, acquisitions and consolidations, it is likely you have payer contracts that you are allowing discounts to – that you never intended. This is most often the case with PPO network contracts that can be accessed by multiple payers, often through secondary, downstream relationships.
Also, the payer you originally contracted with may have been acquired, resulting in situations where:
- You are now passing along higher discounts to a payer that previously had a relatively small discount or you chose not to contract with.
- You are now receiving lower rates as the result of a payer merger after the payers combined rates most advantageous to them.
In January 2021, UnitedHealth Group announced that its diversified health services company, Optum, and Change Healthcare will merge. This is one of many to come.
SUMMARY
Payer consolidations, mergers, acquisitions, changing market conditions, service mix shifts and increased patient responsibility, all make managing the payer contracts in your portfolio more important than ever.