Hidden Cost of Winning the Rate: What Health Systems Get Wrong in Payer Contracting

Rates aren't the whole story. Negotiation success gets measured by rate increases, but operational clauses — prior auth, medical necessity definitions, documentation standards — quietly erode reimbursement over time. "It may take months to negotiate a contract, but years to live through what you negotiated."

Integration over silos. At University Health, contracting, auditing, and contract management all sit inside the revenue cycle — an uncommon structure that keeps the team accountable for outcomes, not just terms.

Negotiation is relationship management. Know your deal-breakers, but make sure the other side gets some wins too. With payer consolidation and thin staffing, reaching the right person takes texts, calls, emails, and LinkedIn — whatever works.

The real leaks happen post-signature. As University Health's medical group has grown toward 900 providers across more specialties, operational complexity — not the negotiated rate — is where revenue quietly slips away.

Underpayments are harder to catch than denials. Shifting fee schedules (CMS-driven or payer-driven) create variances that require constant reconciliation against what's built into Epic's Resolute Billing System.

AI is already changing the work. What used to take 5 hours to redline an 80-page contract now takes 2–3 minutes with AI tools — but human expertise is still essential to interpret and validate what the AI produces.

Purpose drives the day-to-day. "Our whole goal is to make the mission sustainable — we want to be here 50 years from now." A visible reminder on his desk: "This is my why."

Never Split the Difference by Christopher Voss

Epic Resolute Billing System 

MGMA Payer Contract Playbook

MGMA Analyzing Payer Contracts Playbook

MGMA DataDive (Signature benchmarking resource)

"The race for more revenue in medical groups: What’s your gameplan?" (MGMA Stat article)

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