How to use benchmarks, outcomes, and communication strategy to renegotiate payer contracts.
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Episode 24 | Watch on YouTube
A practice Brandon recently worked with had been in business for over 20 years without ever requesting a rate review. In fact, they had experienced a rate reduction. They did not know they could ask. According to Medical Economics, a modest 2 to 3% increase in reimbursement from a single major payer can result in $500,000 or more in additional annual revenue for a medical practice. You cannot get what you do not ask for.
The core reason is simple: providers keep accepting the rates they are given. Insurance companies are businesses. Their revenue model is built on premiums exceeding the cost of services — what Brandon calls the Giving Tree problem. The tree keeps giving and no one thinks about how to feed it. Understanding this is not pessimism; it is strategic intelligence. You need to know their game before you can play your own.
Qualitative arguments — 'our patients love us,' 'we provide exceptional care' — will not move the needle. Insurance companies respond to numbers. Brandon negotiated a 33% rate increase with United Healthcare by proving he was discharging patients 30% faster than regional averages, that those patients were not being readmitted, and that his practice offered more specialty services than any competitor within a 60-mile radius. MGMA's benchmarking data and AAPC's consulting resources are excellent starting points for building that evidence base.
Personalize your outreach. Research who you are writing to on LinkedIn. Send certified mail. Follow up via phone, email, and social media. Set a 60-day response target and pursue it relentlessly. Frame every communication around what the increase will do for the insurance company — reduced readmissions, lower long-term cost of care, expanded access to specialty services — not around what it will do for you.
Hospital systems use their patient bases as advocates when renegotiating payer contracts. You can consider similar strategies, within your legal boundaries, by keeping patients informed about access issues and encouraging feedback. If you bring in an MGMA or AAPC consultant to present your rate request, you gain the credibility of an independent expert reviewing your data. That external validation can shift the conversation significantly — and for a $20,000 investment that unlocks years of increased reimbursement, the ROI is often undeniable.
