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This episode of the MGMA Insights podcast was recorded live October 10, 2022, in Boston at the Medical Practice Excellence: Leaders Conference. In this conversation, we speak with Doral Jacobsen, FACMPE, CEO, Prosper Beyond, who shared her payer contracting acumen in an interactive session, Payer Contracting 101 - Strategies that Work. Jacobsen will present this session again on November 9th as part of the Medical Practice Excellence: Leaders Conference (DX).
Don’t quite have time to listen to the entire episode? No worries. We’ve compiled an assortment of highlights for your convenience:
(4:49): “One thing that I took away from a value-based care talk was the push toward care at home. As a consultant I am reviewing contracts for clients and a lot of those have home elements now. So it's good to really think through, what do we need to be thinking about? What does that look like? And how do we approach these kinds of contracts?”
(6:55): “You have got to understand your worth as a practice to that payer, and it really helps you get behind your proposal. I think about it as a courage muscle. Our practices sometimes get run over by payers. We're afraid; we think that we can't ask for a raise; we think that no one's going to give us a raise. So, we live in this world where we just kind of give up and payers many times don't make it an easy process, either. This idea about figuring out who you are, and how you add value really helps practices identify the payers that are good relationships for them.”
(8:56): “Is the juice worth the squeeze? And if it's not worth the squeeze, how do we tell the payer this? Because payers oftentimes don't understand the administrative burden components. It's not like the payer offers a value-based program, and then you say no because you think it's going to be too difficult. You've got to give them feedback. … It's just moving these discussions into some more sophisticated dialogue around how (to) implement these programs and make them not administratively burdensome, and reward everyone appropriately.”
(10:20): “One of the things that is really cool is that we have data now. If you're going to be asked to participate in a bundle payment, and you have a target that you have to reach, what we're asking payers now is (to) help us understand where the opportunity is - why would we go sign up for this target when we don't really understand what changes we might need to make in order to tap into some shared savings? So … if you want us to participate in these value-based programs, you've got to help us. You can't just send us a data file and say good luck. We are having discussions with payers where they are walking every single group through what the possible scenarios are. It's so cool and collaborative, and all based on data, which we love.”
(12:11): (On earning the FACMPE) “How it started for me was a study group in Asheville, North Carolina, there were about six or so administrators that wanted to become certified. The body of knowledge was in existence, and we decided what we would do is each take one of the body of knowledge subject matters and become an expert on it and teach it to each other. So we would meet once a month in a conference room, and someone would do HR, someone would do finance and someone would do governance, and we would teach it to each other.”
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We'd love to hear from you. Tell us what you think. Let us know if there's a topic you want us to cover or an expert you would like us to interview. Email us at podcasts@mgma.com.The MGMA Insights podcasts are produced by Daniel Williams, Rob Ketcham and Decklan McGee.
You can now register for the DX Medical Practice Excellence: Leaders Conference, Nov. 8-10. Jacobsen will present Payer Contracting 101 – Strategies that Work, on Wednesday, November 9th.
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