Inside One CFO's 'Collaborative' Payer Strategy

A strong, collaborative relationship with payer partners is essential for one CFO.

At a time when providers can feel like they are at a crossroads with payers, Bridgett Feagin, CFO for Connecticut Children's—a level 1 pediatric trauma center with roughly $600 million in net patient revenue—says building a strong relationship with payers is the key to reducing administrative burdens and denials, and ensuring payment.

But how it is done? Leveraging its payer mix, putting pressure on its commercial payers, and keeping communication open has been key Feagin previously told HealthLeaders.

“It's a collaborative relationship, meaning that [payers] understand our needs and we also understand their business needs as well. So, if it costs $100 to take care of this patient, we at least need to cover our costs,” Feagin said.

Connecticut Children's is a payer mix with close to 60% of Medicaid, and Medicaid does not cover Connecticut Children's costs, Feagin says.

“So, we need our commercial payers to give us a little bit more than the costs. So, we can shift some of that liability over to our commercial payers. And that's just the way it works. They understand that but we are working with the state as well to increase our reimbursement to cover our costs,” Feagin says.

Feagin also explained that a good payer partnership also reduces administrative burdens, such as a denial. “When a payer denies a claim, it creates more administrative work for my team. On the front end, we're talking to payers about what we need to do, to make sure we don't get a denial in the first place.”

But how can you collaborate to ensure that a claim won't be denied?

Having monthly team meetings and keeping communication open with the payers helped ensure claims don’t get denied she says.

“One example would be with our NICU babies. Typically, we're supposed to notify our payers within 48 hours, that the baby is admitted to the hospital,” Feagin said. “However, those parents are not thinking about providing the information, because they have a critically ill child that's been admitted to the ICU.”

“We need to be compassionate and work with the family to get the information and find out who their insurance company is. Sometimes that takes over 48 hours. So, say if it goes to 72 hours, we'll contact the payer and say we'll have this information beyond the 48 hours,” Feagin says.

“Now they'll have it in their system, and they get the authorization done. So that's an example of working with the payer to make sure we don't get a denial on the back end.”