2020 To-Do List: Health Plan Performance Report Card

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A turn of the calendar brings us to a new decade, which means new relationships for health care providers or the continuation of long-standing contracts with health plans. It also means new opportunities to evaluate and monitor these relationships, and more importantly, the effectiveness of their performance. If you cannot readily identify key performance metrics for each major health plan relationship, it is time to develop a Payor Report Card in 2020.

Participating in a health plan's network under a contract guarantees nothing. While your contracts may have defined reimbursement rates, sophisticated health plans dilute your expectations through onerous processes, technical requirements and terms that permit them to reduce or delay reimbursement to your providers. Providers need ready access to the necessary information to understand how its relationships perform, including ratios of payment against expected reimbursement, timeliness of payment, reasons for rejected claims or delayed payments, number of appeals needed, denial root causes, amongst many others, as well as an understanding of what levels are acceptable. Measuring and comparing the performance of your relationships will help drive focused operational improvements, identify key terms for future renewals and ultimately protect your revenue expectations.

If you are not actively monitoring contract performance, implementing a Payor Report Card in 2020 will help drive the performance and improvement desired. 

DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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