How practices win rate increases by framing negotiations around insurer ROI and measurable outcomes.
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Episode 25 | Watch on YouTube
One in four practices Brandon has worked with has secured a rate increase simply by requesting one. Not through a year-long negotiation campaign — just by asking, and by asking intelligently. The most crucial step is not the ask itself. It is making the ROI call to action that tells the insurance company specifically what is in it for them. If you cannot articulate their benefit, you cannot win the conversation. HFMA's resources on payer negotiation provide a detailed framework for building that case.
Their goal is to meet their medical necessity obligation at the lowest possible per-member cost. Period. They do not care about your rent increase or your team's student debt. What they do care about is reduced hospitalizations, faster discharges, lower readmission rates, and population health metrics that keep their own costs down. When you frame your rate request around those outcomes, you are speaking their language.
One of Brandon's most effective tactics: propose a letter of agreement with the insurance company under a trial rate for a defined period. You deliver data proving your value proposition. They adopt the new rate once you have demonstrated results. This removes the fear of commitment on their side and positions you as a partner in outcome improvement rather than a vendor demanding more money.
Your evidence package should include: clinical outcome data from your EMR showing discharge timelines and readmission rates, expense and revenue analysis from QuickBooks or similar, patient satisfaction and net promoter score data, a market study showing your specialty coverage relative to competitors, and a benchmarking comparison using MGMA data or AAPC analysis. If Blue Cross declines — as Brandon found firsthand with one negotiation — you now have the documentation to evaluate whether remaining in-network is even the right strategy for your practice.
Brandon watched multiple practices get ignored until they went public — on LinkedIn, on social media, in professional networks — about payer access problems. The right kind of strategic visibility, especially when it engages your patient community as advocates, can move negotiations that bureaucratic channels never could. Know your legal boundaries. Know your payer. Then make noise in the right places with the right data behind you.
