Managed Care: Understanding the Dynamic Between Payor and Provider

We whole-heartedly believe that the outcome of managed care strategy and its negotiations define the playing field for effective marketing and growth. Understanding the unique market dynamic between payors and providers is an important part of capitalizing on both fronts. In working with hospitals, health systems, and physician groups in their negotiations with multiple payors across markets, our team has observed some common themes this year.

The most prominent trend we have experienced firsthand is the unprecedented level of payor/provider disagreement and acrimony. The industry seemed to take a collective break during COVID, and then, to put it mildly, all hell broke loose.

• Providers started pursuing significant rate increases to compensate for COVID losses, the disappearance of non-operating income, and the massive and unprecedented effect of inflation.  

• Payors kept raising premium rates well above the level of underlying rate increases, as they have for a decade, all while simultaneously pressuring providers with rate cut demands and imposing onerous policies and contract administration requirements.

• Employers began asking questions – demanding to see their data to better understand why their premiums and total healthcare spending were increasing so significantly – only to have payors refuse disclosure, leading to litigation on multiple fronts.

Unlock Health was created to navigate these issues and many others. We are connecting the dots between managed care, marketing, and technology in a way no organization has ever done before. Interested in learning more? Find out more about our managed care team here.