Hello, everyone. This is Christos with Becker's Healthcare.
Thank you so much for tuning in to
the Becker's Healthcare podcast series. Today, we're going
to talk about strategies for smarter payer negotiations.
Joining me for today's discussion is Brett Spark,
who is president and cofounder of Auroras Health.
Brett, thank you for being here today. Yeah.
Thanks for having me. Brett, to start us
off, could you introduce yourself and share a
bit about your work in health care? Sure.
Current state, I'm the president and one of
the founders of Auroras Health. We work in
the tech and service space that are directly
working with payers and providers to to help
support negotiations.
Prior to that, I've had a a long
history in the health care space, with a
large health system starting my career, and then
I ran several privately
owned medical practices and administrators, CEO roles before
that. So
a full history in the health care space,
mainly on the care delivery side.
Yeah. Very cool. Like a lot of, executives
we have on our podcast, you've worn a
lot of hats throughout your career, and that
leads to a terrific breadth of experience.
Next one I wanna cover is, so with
the ongoing consolidation wave driven by a rebound
in private equity transactions and heightened regulatory scrutiny,
what new contract challenges have emerged in the
second half of the year, and how can
organizations proactively protect their position?
Yeah.
Second half of the year and and I
would assume going into '26 as well, we've
seen a lot of
tightened
kind of payer oversight for organizations
where, obviously, payers are are being pinched. We're
seeing premiums go up, which has become somewhat
of the norm. But from a practice perspective,
that means
they're seeing a lot more restriction, a lot
more prior auth denials,
which isn't new in the space.
But we are seeing a lot of a
lot of challenges that that come with a
cash flow position for organizations that need to
manage that from a resource perspective, but also,
do they truly understand all of the dynamics
that exist
within that 60 page contract that that payers
have with with organizations?
Brett,
also, what blind spots should providers be specifically
mindful of as they navigate these challenges?
I think a big part of it
are the blind spots or the revenue leakage
that exists
within the payer or the the payer contract
that practices have.
Our organization
has been around for for five years now.
We work with
over 200
organizations,
and I can say we've had zero that
have their contracts and fee schedules in hand
for all the payers that they work with,
which is great. Our organization will go out
and get those, but it highlights a concern
that there's a lot buried in in that
language. And some of what's buried in there
can lead to missed revenue opportunities,
or it can lead to some of these
restrictions being placed on practices that they have
no idea what's going on behind the scenes.
So that's a big part of of what
exists in some of those blind spots.
Brett, thank you for outlining all that. Next
question I have for you is, so providers
are increasingly
entering negotiations with pricing transparency tools and comparative
data. In this context, what does an effective
contract analytics strategy look like? And can you
share an example of where this approach truly
shifted negotiation outcomes?
Yeah. I I would say the the tools
are increasingly
available. You know, I say in talks that
I've had with other groups that there's more
data available today than than ever before with
from a payer perspective, with price transparency,
with the ability to go out and get
analytics from other organizations
and and really measure yourself against competition, not
just against your your internal
payer relationships.
But I will also say that
majority of the organizations are not capitalizing on
that yet. You know, today,
there's organizations that get excited about finding out
what what Bob's Ortho group gets paid from
up the street,
but they're not aligning that data with their
current state to use it as a decision
making tool. And,
really, where it starts is is what I
mentioned before is that organizations need to get
their contracts, need to get their fee schedules.
They need to get whatever the reimbursement models
into a a digital environment so they could
align it with their current state, with their
volumes, with their site of service.
And then you can layer on some of
those external
data pieces to actually inform decisions that you're
making. So there's a lot available.
What we're trying to help navigate and what
organizations need to focus a lot on is
kind of starting right to end right. Take
the time upfront to to get all that
information into a into a position where you
can look at what's valuable to your organization
before you're going in and trying to to
leverage conversational payers.
Got it. And so to follow-up with that,
Brett, certainly, value based care has been a
huge topic of conversation across the health care
space for several years now. So, specifically, what
I have for you is how is CMS's
continued push toward value based models influencing these
strategies?
Yeah. And and it's not just value based
care. You know, value based care has been
around for a long time, and I will
say there's not a defined
version of value based care. If you ask
10 people what the definition is, you'll probably
get 10 different answers.
And that's the challenge. But it's also other
alternative payment models as well. I think that
the biggest thing to be thinking about is
that
there there is going to be changes in
how health care is paid for, how health
care is reimbursed both at a government and
a commercial level.
What organizations
need to understand is that if they are
being measured on quality,
they have to understand what where that data
is coming from, who's measuring those data points,
who's tracking those data points, and then aligning
that with kind of the risk tolerance. Are
they signing up for something that they can
support and understand when they get paid,
or are they just signing up because
the payer's flashing a 5% increase if they
hit certain metrics?
A lot of what's happening is
it's the shiny penny. It's, hey. This is
value based care. You can make 5% more,
but we'll track the data internally
at a payer perspective, and there's really no
alignment with what's actually happening on a day
to day practice side. So
there's another gap or a revenue leakage opportunity
there. Got it.
Brett, so beyond just getting better rates, what
does success look like when organizations take a
more holistic approach to contract performance? And to
add on to that, how can this integrated
strategy shape outcomes in both the short term
and the long term? Yeah. I think holistic
is is the keyword there. It's one that
our organization uses a lot.
When you're looking at individual payer relationships,
you need to look at them holistically,
not just on the commercial side. You know,
what what are you in from a relationship
perspective with this payer?
Is it commercial? Is it Medicare Advantage? Is
it managed Medicaid? Is it these alternative payment
models? And you need to look at that
holistically
before you're deciding what the best outcome is
from a negotiation standpoint.
And then once you've built that holistic picture
of their relationship with that payer, then you
can track on the back end, are the
payers holding up their end of the bargain?
And that's where we're seeing a lot of
inefficiencies,
inaccuracies
happening, not only
on the front end negotiation side, but on
the back end payout side of things. So
not denials, not prior authorizations, but for for
what's actually getting paid for, clean claims that
are getting paid, we're seeing inaccuracies
as it relates to what the actual contract
terms are. But organizations are not set up
appropriately on the front end to catch those.
And so,
again, holistic is is the big term for
that. You can't just look at one aspect
or one product type of your relationship with
a payer. You need to look at both
the front and back end of that and
make sure you're you're putting the tools in
place to be to be able to measure
it appropriately.
Understand. Thanks a lot for everything you've outlined
today, Brett. So is there anything else you
wanna cover on the podcast today?
No. I I think well, by no, I
mean, yes.
A big part of what I think we're
we're pushing for in our organization, and it
can be done with with external partners or
internal partners as well, the right resources internally,
is get excited about the datas that's available.
But, on the front end of things, make
sure you have your house in order. Make
sure you have the contract terms, conditions. Make
sure you understand
exactly what you've signed up for, not with
your biggest payer, but with with all your
payers. You need you need a focused attention
on on all the relationships,
and that will help you maximize on the
revenue side on the back end of it.
Perfect. Brett, thank you so much for all
your time and insights today. We also want
to thank our podcast sponsor, of course, Aurora's
Health. You can tune in to more podcasts
from Becker's Health Care by visiting our podcast
page at beckers hospital review dot com.