Payer Contracting

Value-Based Care Fails in the Contract, Not the Clinic

Five (5) things every healthcare finance leader needs settled before signing a value-based care agreement with a payer

New Negotiators Don't Lose Deals Over Rates. They Lose Them Over Words.

Eight managed care contracting terms every new negotiator, benefits manager, and plan sponsor needs to know before their first payer meeting

AI Isn't Coming for Your Contracting Job. Complacency Is.

What managed care and payer relations professionals need to change before artificial intelligence changes it for them

Nobody Was Checking. One Analyst Found $2 Million.

The most innovative payment methodology means nothing if nobody checks whether it works. Without that, it's not an innovation. It's an assumption.

Your Payer's Directory Is Wrong. Your Contract Doesn't Care.

Why the most-used document in managed care gets the least attention by your contracting team.

You Don't Have a Contract Portfolio. You Have a Pile.

The payer contracts were never the asset. What they add up to is the asset, and until somebody does the math, you're just managing a very well-organized pile of documents.

Walking Away Isn't a Strategy. It's What You Do Without One.

When the only remedy available is contract termination, that is what gets used. Not because it is right, but because it is the only thing left in the drawer.

Your UR Nurse Holds Your Best Payer Contract Evidence

Your best enforcement record already exists. It's sitting in a queue on the wrong floor, in front of someone nobody thought to ask.

The Person Across the Table Can't Say Yes. Find Out Who Can.

Your counterpart isn't stalling you. She can't say yes, and nobody in the room is going to tell you that.

The Hidden Cost of Winning the Rate (MGMA Insights Podcast)

MGMA Insights Podcast - Daniel Williams, Senior Editor & Host

Your Contracts Are Intact. Your Patient Mix Isn't.

The agreements are signed. The rates are set. The population they were built for is gone.

You Inherited a Payer Problem You Didn't Create. Start Here.

How years of absorbed underpayments teach payers to test you, and three habits new contract managers can build from day one

Payer Relations and Patient Access Are One System on Two Floors

Seven ways to connect contracting and patient access so the terms you negotiate actually hold up at the front desk

Ghosted by a Payer? Eight Ways to Restart the Negotiation

Why silence in a payer negotiation is usually logistical, not personal, and how to bring a counterpart back to the table

7 Terms to Get Right in Transplant Network Contracts

Seven terms to get right in transplant network agreements, from inclusion criteria and phased bundled payments to stop-loss and quality metrics

Using AI in Payer Contracting? Build the Sandbox First

Why a public-source contract negotiation playbook is the safest way to start using AI in payer contracting

The Contract You Signed Isn't the Contract You're Getting Paid On

Why administrative friction, not fee schedules, is the real managed care battlefield now

Withholding Data From a Payer Doesn't Protect Your Leverage

Five strategies for building real transparency into managed care payer-provider negotiations

Payment Integrity Audits Don't Have to Be a Fight

How payers and providers can turn audits from a source of friction into a shared framework for fairness, transparency, and accurate payment

Three Decades. Three Pillars. One System for Payer Strategy.

People, Portfolio, and Process, the proven framework behind multi-billion-dollar payer portfolio results

Managed Care 101: What It Means and What It Doesn't

Three fundamentals of the managed care concept every payer, provider, health plan sponsor, and plan member should actually understand

Bring Revenue Cycle In Before You Negotiate, Not After You Sign

Six practices for aligning revenue cycle leaders with your contract negotiation team, before the ink dries instead of after

School Won't Teach You to Negotiate Payer Contracts. Mentors Will.

Why mentorship closes the gap that no healthcare finance degree program covers, and how to build it into your career on purpose

The 20 Payer Contract Clauses That Put Providers Most at Risk

A practical checklist of the clauses that quietly tilt a payer contract against providers, and what to do about each one

Payer Contracts Should Pay for Social Needs, Not Just Diagnoses

Six ways to build Social Determinants of Health into payer contract language and payment structures