1 00:00:00,160 --> 00:00:02,319 Hello, everyone. This is Christos with Becker's Healthcare. 2 00:00:02,319 --> 00:00:03,600 Thank you so much for tuning in to 3 00:00:03,600 --> 00:00:06,040 the Becker's Healthcare podcast series. Today, we're going 4 00:00:06,040 --> 00:00:08,419 to talk about strategies for smarter payer negotiations. 5 00:00:08,880 --> 00:00:11,039 Joining me for today's discussion is Brett Spark, 6 00:00:11,039 --> 00:00:12,880 who is president and cofounder of Auroras Health. 7 00:00:12,880 --> 00:00:14,559 Brett, thank you for being here today. Yeah. 8 00:00:14,559 --> 00:00:16,364 Thanks for having me. Brett, to start us 9 00:00:16,364 --> 00:00:17,964 off, could you introduce yourself and share a 10 00:00:17,964 --> 00:00:20,125 bit about your work in health care? Sure. 11 00:00:20,125 --> 00:00:22,685 Current state, I'm the president and one of 12 00:00:22,685 --> 00:00:25,585 the founders of Auroras Health. We work in 13 00:00:26,045 --> 00:00:28,685 the tech and service space that are directly 14 00:00:28,685 --> 00:00:31,070 working with payers and providers to to help 15 00:00:31,070 --> 00:00:31,970 support negotiations. 16 00:00:32,750 --> 00:00:34,750 Prior to that, I've had a a long 17 00:00:34,750 --> 00:00:36,909 history in the health care space, with a 18 00:00:36,909 --> 00:00:39,149 large health system starting my career, and then 19 00:00:39,149 --> 00:00:40,530 I ran several privately 20 00:00:41,229 --> 00:00:44,590 owned medical practices and administrators, CEO roles before 21 00:00:44,590 --> 00:00:45,409 that. So 22 00:00:45,835 --> 00:00:47,675 a full history in the health care space, 23 00:00:47,914 --> 00:00:49,695 mainly on the care delivery side. 24 00:00:49,995 --> 00:00:52,395 Yeah. Very cool. Like a lot of, executives 25 00:00:52,395 --> 00:00:54,075 we have on our podcast, you've worn a 26 00:00:54,075 --> 00:00:55,995 lot of hats throughout your career, and that 27 00:00:55,995 --> 00:00:58,175 leads to a terrific breadth of experience. 28 00:00:59,159 --> 00:01:00,679 Next one I wanna cover is, so with 29 00:01:00,679 --> 00:01:03,399 the ongoing consolidation wave driven by a rebound 30 00:01:03,399 --> 00:01:07,099 in private equity transactions and heightened regulatory scrutiny, 31 00:01:07,400 --> 00:01:09,319 what new contract challenges have emerged in the 32 00:01:09,319 --> 00:01:10,920 second half of the year, and how can 33 00:01:10,920 --> 00:01:13,420 organizations proactively protect their position? 34 00:01:14,295 --> 00:01:14,795 Yeah. 35 00:01:15,254 --> 00:01:17,174 Second half of the year and and I 36 00:01:17,174 --> 00:01:19,575 would assume going into '26 as well, we've 37 00:01:19,575 --> 00:01:20,715 seen a lot of 38 00:01:21,254 --> 00:01:21,754 tightened 39 00:01:22,614 --> 00:01:24,795 kind of payer oversight for organizations 40 00:01:25,334 --> 00:01:27,575 where, obviously, payers are are being pinched. We're 41 00:01:27,575 --> 00:01:30,670 seeing premiums go up, which has become somewhat 42 00:01:30,670 --> 00:01:33,090 of the norm. But from a practice perspective, 43 00:01:33,230 --> 00:01:33,890 that means 44 00:01:34,189 --> 00:01:36,510 they're seeing a lot more restriction, a lot 45 00:01:36,510 --> 00:01:38,209 more prior auth denials, 46 00:01:38,750 --> 00:01:40,450 which isn't new in the space. 47 00:01:40,990 --> 00:01:42,670 But we are seeing a lot of a 48 00:01:42,670 --> 00:01:44,625 lot of challenges that that come with a 49 00:01:44,625 --> 00:01:46,944 cash flow position for organizations that need to 50 00:01:46,944 --> 00:01:50,405 manage that from a resource perspective, but also, 51 00:01:51,105 --> 00:01:53,745 do they truly understand all of the dynamics 52 00:01:53,745 --> 00:01:54,405 that exist 53 00:01:54,704 --> 00:01:57,185 within that 60 page contract that that payers 54 00:01:57,185 --> 00:01:58,484 have with with organizations? 55 00:01:59,799 --> 00:02:00,299 Brett, 56 00:02:00,680 --> 00:02:03,180 also, what blind spots should providers be specifically 57 00:02:03,400 --> 00:02:05,659 mindful of as they navigate these challenges? 58 00:02:06,439 --> 00:02:08,219 I think a big part of it 59 00:02:08,599 --> 00:02:11,080 are the blind spots or the revenue leakage 60 00:02:11,080 --> 00:02:11,900 that exists 61 00:02:12,435 --> 00:02:15,474 within the payer or the the payer contract 62 00:02:15,474 --> 00:02:16,694 that practices have. 63 00:02:17,155 --> 00:02:17,814 Our organization 64 00:02:18,275 --> 00:02:20,754 has been around for for five years now. 65 00:02:20,754 --> 00:02:21,655 We work with 66 00:02:22,435 --> 00:02:23,495 over 200 67 00:02:23,555 --> 00:02:24,055 organizations, 68 00:02:24,435 --> 00:02:27,235 and I can say we've had zero that 69 00:02:27,235 --> 00:02:29,900 have their contracts and fee schedules in hand 70 00:02:29,960 --> 00:02:31,879 for all the payers that they work with, 71 00:02:31,879 --> 00:02:34,280 which is great. Our organization will go out 72 00:02:34,280 --> 00:02:36,699 and get those, but it highlights a concern 73 00:02:36,840 --> 00:02:39,240 that there's a lot buried in in that 74 00:02:39,240 --> 00:02:41,844 language. And some of what's buried in there 75 00:02:41,844 --> 00:02:43,944 can lead to missed revenue opportunities, 76 00:02:44,245 --> 00:02:46,164 or it can lead to some of these 77 00:02:46,164 --> 00:02:48,245 restrictions being placed on practices that they have 78 00:02:48,245 --> 00:02:50,405 no idea what's going on behind the scenes. 79 00:02:50,405 --> 00:02:52,884 So that's a big part of of what 80 00:02:52,884 --> 00:02:54,745 exists in some of those blind spots. 81 00:02:55,389 --> 00:02:57,729 Brett, thank you for outlining all that. Next 82 00:02:57,789 --> 00:02:59,729 question I have for you is, so providers 83 00:02:59,870 --> 00:03:00,449 are increasingly 84 00:03:01,150 --> 00:03:04,269 entering negotiations with pricing transparency tools and comparative 85 00:03:04,269 --> 00:03:06,909 data. In this context, what does an effective 86 00:03:06,909 --> 00:03:09,354 contract analytics strategy look like? And can you 87 00:03:09,354 --> 00:03:11,114 share an example of where this approach truly 88 00:03:11,114 --> 00:03:12,735 shifted negotiation outcomes? 89 00:03:13,514 --> 00:03:15,754 Yeah. I I would say the the tools 90 00:03:15,754 --> 00:03:16,495 are increasingly 91 00:03:16,794 --> 00:03:18,794 available. You know, I say in talks that 92 00:03:18,794 --> 00:03:20,474 I've had with other groups that there's more 93 00:03:20,474 --> 00:03:22,955 data available today than than ever before with 94 00:03:23,419 --> 00:03:26,080 from a payer perspective, with price transparency, 95 00:03:26,459 --> 00:03:28,459 with the ability to go out and get 96 00:03:28,459 --> 00:03:29,919 analytics from other organizations 97 00:03:30,219 --> 00:03:32,860 and and really measure yourself against competition, not 98 00:03:32,860 --> 00:03:34,400 just against your your internal 99 00:03:34,780 --> 00:03:35,680 payer relationships. 100 00:03:36,379 --> 00:03:38,080 But I will also say that 101 00:03:38,385 --> 00:03:40,944 majority of the organizations are not capitalizing on 102 00:03:40,944 --> 00:03:42,485 that yet. You know, today, 103 00:03:43,025 --> 00:03:45,585 there's organizations that get excited about finding out 104 00:03:45,585 --> 00:03:47,985 what what Bob's Ortho group gets paid from 105 00:03:47,985 --> 00:03:48,805 up the street, 106 00:03:49,264 --> 00:03:52,064 but they're not aligning that data with their 107 00:03:52,064 --> 00:03:54,209 current state to use it as a decision 108 00:03:54,209 --> 00:03:55,669 making tool. And, 109 00:03:56,049 --> 00:03:57,729 really, where it starts is is what I 110 00:03:57,729 --> 00:04:00,370 mentioned before is that organizations need to get 111 00:04:00,370 --> 00:04:02,610 their contracts, need to get their fee schedules. 112 00:04:02,610 --> 00:04:05,110 They need to get whatever the reimbursement models 113 00:04:05,594 --> 00:04:07,915 into a a digital environment so they could 114 00:04:07,915 --> 00:04:09,995 align it with their current state, with their 115 00:04:09,995 --> 00:04:11,694 volumes, with their site of service. 116 00:04:11,995 --> 00:04:13,594 And then you can layer on some of 117 00:04:13,594 --> 00:04:14,335 those external 118 00:04:15,034 --> 00:04:17,995 data pieces to actually inform decisions that you're 119 00:04:17,995 --> 00:04:20,419 making. So there's a lot available. 120 00:04:20,959 --> 00:04:22,959 What we're trying to help navigate and what 121 00:04:22,959 --> 00:04:25,199 organizations need to focus a lot on is 122 00:04:25,199 --> 00:04:27,360 kind of starting right to end right. Take 123 00:04:27,360 --> 00:04:29,439 the time upfront to to get all that 124 00:04:29,439 --> 00:04:32,000 information into a into a position where you 125 00:04:32,000 --> 00:04:34,714 can look at what's valuable to your organization 126 00:04:34,935 --> 00:04:37,094 before you're going in and trying to to 127 00:04:37,094 --> 00:04:38,794 leverage conversational payers. 128 00:04:39,414 --> 00:04:41,254 Got it. And so to follow-up with that, 129 00:04:41,254 --> 00:04:43,254 Brett, certainly, value based care has been a 130 00:04:43,254 --> 00:04:45,495 huge topic of conversation across the health care 131 00:04:45,495 --> 00:04:48,439 space for several years now. So, specifically, what 132 00:04:48,439 --> 00:04:49,979 I have for you is how is CMS's 133 00:04:50,120 --> 00:04:53,079 continued push toward value based models influencing these 134 00:04:53,079 --> 00:04:53,579 strategies? 135 00:04:54,279 --> 00:04:56,279 Yeah. And and it's not just value based 136 00:04:56,279 --> 00:04:57,879 care. You know, value based care has been 137 00:04:57,879 --> 00:04:59,959 around for a long time, and I will 138 00:04:59,959 --> 00:05:01,339 say there's not a defined 139 00:05:01,975 --> 00:05:03,574 version of value based care. If you ask 140 00:05:03,574 --> 00:05:05,975 10 people what the definition is, you'll probably 141 00:05:05,975 --> 00:05:07,194 get 10 different answers. 142 00:05:07,975 --> 00:05:10,295 And that's the challenge. But it's also other 143 00:05:10,295 --> 00:05:13,095 alternative payment models as well. I think that 144 00:05:13,095 --> 00:05:14,855 the biggest thing to be thinking about is 145 00:05:14,855 --> 00:05:15,355 that 146 00:05:15,959 --> 00:05:18,120 there there is going to be changes in 147 00:05:18,120 --> 00:05:19,879 how health care is paid for, how health 148 00:05:19,879 --> 00:05:22,040 care is reimbursed both at a government and 149 00:05:22,040 --> 00:05:23,180 a commercial level. 150 00:05:23,720 --> 00:05:24,459 What organizations 151 00:05:24,759 --> 00:05:26,519 need to understand is that if they are 152 00:05:26,519 --> 00:05:27,899 being measured on quality, 153 00:05:28,285 --> 00:05:30,685 they have to understand what where that data 154 00:05:30,685 --> 00:05:33,264 is coming from, who's measuring those data points, 155 00:05:33,485 --> 00:05:35,884 who's tracking those data points, and then aligning 156 00:05:35,884 --> 00:05:37,805 that with kind of the risk tolerance. Are 157 00:05:37,805 --> 00:05:40,125 they signing up for something that they can 158 00:05:40,125 --> 00:05:42,449 support and understand when they get paid, 159 00:05:43,009 --> 00:05:44,870 or are they just signing up because 160 00:05:45,330 --> 00:05:47,810 the payer's flashing a 5% increase if they 161 00:05:47,810 --> 00:05:48,790 hit certain metrics? 162 00:05:49,250 --> 00:05:50,870 A lot of what's happening is 163 00:05:51,730 --> 00:05:54,129 it's the shiny penny. It's, hey. This is 164 00:05:54,129 --> 00:05:56,629 value based care. You can make 5% more, 165 00:05:57,164 --> 00:05:59,104 but we'll track the data internally 166 00:05:59,724 --> 00:06:02,604 at a payer perspective, and there's really no 167 00:06:02,604 --> 00:06:05,324 alignment with what's actually happening on a day 168 00:06:05,324 --> 00:06:06,784 to day practice side. So 169 00:06:07,164 --> 00:06:09,745 there's another gap or a revenue leakage opportunity 170 00:06:09,805 --> 00:06:11,100 there. Got it. 171 00:06:11,740 --> 00:06:14,620 Brett, so beyond just getting better rates, what 172 00:06:14,620 --> 00:06:16,939 does success look like when organizations take a 173 00:06:16,939 --> 00:06:19,899 more holistic approach to contract performance? And to 174 00:06:19,899 --> 00:06:21,819 add on to that, how can this integrated 175 00:06:21,819 --> 00:06:23,819 strategy shape outcomes in both the short term 176 00:06:23,819 --> 00:06:26,654 and the long term? Yeah. I think holistic 177 00:06:26,714 --> 00:06:29,274 is is the keyword there. It's one that 178 00:06:29,274 --> 00:06:31,214 our organization uses a lot. 179 00:06:31,514 --> 00:06:33,774 When you're looking at individual payer relationships, 180 00:06:34,235 --> 00:06:35,774 you need to look at them holistically, 181 00:06:36,074 --> 00:06:38,235 not just on the commercial side. You know, 182 00:06:38,235 --> 00:06:40,709 what what are you in from a relationship 183 00:06:40,709 --> 00:06:42,170 perspective with this payer? 184 00:06:42,709 --> 00:06:44,790 Is it commercial? Is it Medicare Advantage? Is 185 00:06:44,790 --> 00:06:47,509 it managed Medicaid? Is it these alternative payment 186 00:06:47,509 --> 00:06:49,269 models? And you need to look at that 187 00:06:49,269 --> 00:06:49,769 holistically 188 00:06:50,310 --> 00:06:52,709 before you're deciding what the best outcome is 189 00:06:52,709 --> 00:06:54,329 from a negotiation standpoint. 190 00:06:54,925 --> 00:06:57,165 And then once you've built that holistic picture 191 00:06:57,165 --> 00:06:59,165 of their relationship with that payer, then you 192 00:06:59,165 --> 00:07:01,405 can track on the back end, are the 193 00:07:01,405 --> 00:07:03,405 payers holding up their end of the bargain? 194 00:07:03,405 --> 00:07:05,264 And that's where we're seeing a lot of 195 00:07:05,405 --> 00:07:05,905 inefficiencies, 196 00:07:06,285 --> 00:07:06,785 inaccuracies 197 00:07:07,085 --> 00:07:08,305 happening, not only 198 00:07:08,759 --> 00:07:11,160 on the front end negotiation side, but on 199 00:07:11,160 --> 00:07:13,899 the back end payout side of things. So 200 00:07:14,199 --> 00:07:17,319 not denials, not prior authorizations, but for for 201 00:07:17,319 --> 00:07:19,879 what's actually getting paid for, clean claims that 202 00:07:19,879 --> 00:07:21,814 are getting paid, we're seeing inaccuracies 203 00:07:22,435 --> 00:07:24,435 as it relates to what the actual contract 204 00:07:24,435 --> 00:07:26,995 terms are. But organizations are not set up 205 00:07:26,995 --> 00:07:28,995 appropriately on the front end to catch those. 206 00:07:28,995 --> 00:07:29,735 And so, 207 00:07:30,194 --> 00:07:32,514 again, holistic is is the big term for 208 00:07:32,514 --> 00:07:34,935 that. You can't just look at one aspect 209 00:07:35,170 --> 00:07:37,569 or one product type of your relationship with 210 00:07:37,569 --> 00:07:39,410 a payer. You need to look at both 211 00:07:39,410 --> 00:07:41,009 the front and back end of that and 212 00:07:41,009 --> 00:07:43,170 make sure you're you're putting the tools in 213 00:07:43,170 --> 00:07:44,930 place to be to be able to measure 214 00:07:44,930 --> 00:07:45,670 it appropriately. 215 00:07:46,610 --> 00:07:49,134 Understand. Thanks a lot for everything you've outlined 216 00:07:49,134 --> 00:07:50,574 today, Brett. So is there anything else you 217 00:07:50,574 --> 00:07:52,194 wanna cover on the podcast today? 218 00:07:53,375 --> 00:07:55,774 No. I I think well, by no, I 219 00:07:55,774 --> 00:07:56,435 mean, yes. 220 00:07:57,615 --> 00:08:00,014 A big part of what I think we're 221 00:08:00,014 --> 00:08:02,095 we're pushing for in our organization, and it 222 00:08:02,095 --> 00:08:04,899 can be done with with external partners or 223 00:08:04,899 --> 00:08:07,699 internal partners as well, the right resources internally, 224 00:08:07,699 --> 00:08:10,839 is get excited about the datas that's available. 225 00:08:11,139 --> 00:08:13,139 But, on the front end of things, make 226 00:08:13,139 --> 00:08:14,740 sure you have your house in order. Make 227 00:08:14,740 --> 00:08:17,995 sure you have the contract terms, conditions. Make 228 00:08:17,995 --> 00:08:18,894 sure you understand 229 00:08:19,274 --> 00:08:21,754 exactly what you've signed up for, not with 230 00:08:21,754 --> 00:08:24,074 your biggest payer, but with with all your 231 00:08:24,074 --> 00:08:26,074 payers. You need you need a focused attention 232 00:08:26,074 --> 00:08:27,454 on on all the relationships, 233 00:08:27,914 --> 00:08:29,675 and that will help you maximize on the 234 00:08:29,675 --> 00:08:31,410 revenue side on the back end of it. 235 00:08:31,810 --> 00:08:33,730 Perfect. Brett, thank you so much for all 236 00:08:33,730 --> 00:08:35,730 your time and insights today. We also want 237 00:08:35,730 --> 00:08:38,289 to thank our podcast sponsor, of course, Aurora's 238 00:08:38,289 --> 00:08:39,970 Health. You can tune in to more podcasts 239 00:08:39,970 --> 00:08:41,970 from Becker's Health Care by visiting our podcast 240 00:08:41,970 --> 00:08:44,629 page at beckers hospital review dot com.