Payors are increasingly finding more ways to deny claims.  Making matters worse, a lack of transparency leaves healthcare providers with little to no insight into the source of the denials, how to dispute them, or how to keep them from happening in the future.  Meri Gordon and Adam Dietrich, Shareholders at Polsinelli, have devoted their practice to addressing these payor games head-on.  In their roles, they’ve gained a deep understanding of the healthcare legal landscape and routinely represent clients in connection with an array of managed care disputes and litigation.

On Thursday, 11/9 from 11 am – 12 pm CT, Meri and Adam discussed recent trends in managed care contract denials, including an exploration of the underlying factors, effective strategies for addressing denials (from a contracting and litigation perspective), and the legal implications associated with these challenges.

Read full recap blog of Polsinelli’s session here.

Health systems are facing increased financial and operational pressures driven by the lingering effects of the COVID-19 pandemic, rising costs to deliver care, evolving reimbursement models, and bad payer behavior.  It’s important that we shift our collective thinking, adopt a proactive approach, and seriously consider revenue diversification and growth strategies that previously may have been considered too disruptive.

Nick Stefanizzi, CEO of Northwell Direct, shares some lessons learned in launching a leading health system owned direct-to-employer business and the benefits these relationships can provide to both employers and health systems. Not only can these relationships provide a valuable alternative revenue source, improve market share, and enable an alternative pathway to care for the community served by a health system, but they can also support a recalibration in the balance of power between health systems and the traditional insurance companies, which will be increasingly important as negotiations continue to grow more and more acrimonious.

Following this session, you’ll have with a fresh perspective on how to address the burdens the nationwide provider organizations have been grappling with and a new outlook on how health systems can have a transformative impact on how care is organized, delivered, and financed through direct-to-employer relationships.

Recap blog coming shortly.

With 89 hospitals spanning 22 states, and thousands of physicians across primary and specialty practices, Trinity Health is one of the country’s largest not-for-profit health systems.

Mr. Kilpinen, SVP of Payor Strategy & Product Development, and Mr. Beverwyk, VP of National Payor Contracting, will share insights about the dynamics and trends they have experienced in recent negotiations with both national and regional payors.

They will also discuss Trinity Health’s effort proactively educate key audiences about the mounting challenges healthcare providers face, as well as the lack of real partnership and fair payments from payors that are essential to addressing them.

Register to save your spot for this virtual session today.

In today’s challenging macro-economic environment, payer-provider partnerships are shifting away from aspirational goals of creating long-term value to more practical considerations. Organizations are asking each hard questions about value creation, the capabilities they seek in partner organizations, and the nature of joint opportunities. In this session, John Poziemski from Kaufman Hall will explore how health systems and health plans can craft effective, sustainable partnerships in an uncertain future. Registration for this session will be opening soon.

Register to save your spot for this virtual session today.

This session aims to provide healthcare providers with comprehensive insights into managed care contract denials, including an exploration of the underlying factors, effective strategies for addressing denials, and the implications associated with these challenges.

Register to save your spot for this virtual session today.

Session details and registration link coming soon.