9 - Insurance Payer Contract Negotiation: An Insider's Guide to Leverage
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9 - Insurance Payer Contract Negotiation: An Insider's Guide to Leverage
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In this episode of the Regional Hospital Voice, Mark interviews Scott Ellsworth, a former health plan executive who spent 30 years on the payer side, including Market President at Excellus BlueCross BlueShield and President and CEO of Centene's seven-state western region. In 2022 he left the payer side and built a firm that works only for providers, after a health system brought him in to help undo a bad Blue Cross contract.
Scott explains how hospitals can use price transparency data to anchor rate requests and why he targets the 75th percentile of the market. He lays out the payer playbook of “start late, go slow, run the clock out.” He describes how dropping the bottom half of Medicare Advantage plans can lift yields by 200 to 300 basis points, and shares his view on why value-based contracts favor payers.
Scott’s message to hospital leaders is that every hospital has leverage. The key is knowing how to use it.
Learn more about Scott's work HERE
Connect with Scott on LinkedIn HERE
Apply to be a guest on the show HERE