By Kate Cavero
It’s finally my favorite time of the year: negotiation season! (Did you think I was going to say fall)? For providers heading into discussions with payors, one principle stands out: communicating early with stakeholders is the key to success.
Why Timing Matters
Payor negotiations are complex, with multiple stakeholders, competing financial pressures, and your organization’s reputation on the line. Waiting until out-of-network deadlines loom forces providers to be reactive – even when they have a justifiable negotiating position and a compelling narrative. Starting conversations early gives health system leaders space to align expectations, build trust, and avoid the pressures of last-minute decisions.
Open Enrollment is Upon Us
This year’s open enrollment period is a powerful opportunity to engage our shared stakeholders and show the payor the value of having your organization in-network. Our patients are payors’ members, brokers are extensions of their sales teams, and employers are their customers. Put simply, these groups can help show the payor how your organization’s presence—or absence— in their network impacts their plan choice and satisfaction.
- Patients – Open enrollment can be overwhelming for patients. Benefits change, networks shift, and misinformation spreads quickly. When providers reach out early, they help patients make informed decisions and reinforce trust. Patients who understand their options are more likely to stay connected to your care.
- Brokers are guiding those decisions based on the information they have about network status. By reaching out early with network updates, cost transparency, and patient experience, you’re positioning yourself as a trusted partner vs. last-minute problem creator. The earlier the dialogue, the more influence you have.
- Employers want networks that balance affordability with quality. While many of them have already selected their benefits provider for the coming year, they carry immense influence as customers of plans. They’re keen to ensure the plan they’ve selected is a competitive benefit for hiring and retention purposes, and for the overall wellbeing of their employees. Engaging them early can allow them time to contact the payor and urge them to keep your providers in network. It may also give them time to offer an alternate insurance plan to their employees.
Building Trust Through Transparency
Transparency is currency in conversations with these stakeholders. Sharing data on patient outcomes, cost savings initiatives, and quality metrics allows providers to highlight the value they bring to the community they serve, gain supporters, and reinforce their negotiating position. Frequent communication with employers, brokers and patients – not to mention internal teams, who can be providers’ biggest champions – builds trust. Springing out-of-network news on these groups, when they have no time to engage or plan for such a change, not only destroys trust, it also degrades your reputation.
The Bottom Line
Negotiations are about more than contracts—they’re about relationships. In my experience, providers who show up early, stay consistent, and communicate openly secure stronger agreements, while also minimizing confusion and churn, and building credibility and demonstrating their value.
As negotiations heat up this fall, remember: timing and transparency are your strongest tools.
BPD can help. Reach out to Kate Caverno directly at kcaverno@bpdhealthcare.comor Contact Us here.
