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Managing Managed Care

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With the rise of managed care in hearing healthcare, practices are working harder than ever to grow their revenue, but that doesn’t mean your goals are unreachable. With an understanding of your current business and the adjustments you need to make, you can stay on track to grow your practice.

Here is a breakdown of the most important questions to address when navigating managed care:

What are some common industry trends when it comes to managed care?

When it comes to managed care, one of the most common industry trends practices are encountering is an overall increase in managed care plans. Many practices are seeing a significantly higher ratio of managed care to private paid patients. It’s even higher of a ratio than practices can anticipate because patients are sometimes booked as private pay patients. Providers then realize that they are managed care patients when they’re making a treatment recommendation. This causes a lot of scheduling inefficiencies, and it makes it challenging to hit the revenue goal when you can’t accurately predict your payer mixes.

Now more than ever, practices are also deciding to opt out of certain plans. Practice owners will review their managed care contracts, look at the fitting fees per contract, how much time they’re spending with these plans, and make the hard decisions to opt out of plans that are not a good fit for their practice.

What is the role of a business assessment?

The role of a business assessment is to create a good picture of your current business landscape so you can get a detailed look at things like revenue, sales, the payer mix, your sales and marketing plan, your management, and your organization. It allows you to get a full assessment of your current situation so you can evaluate where you are today and make a plan for where you want to go.

When it comes to managed care, a business assessment is especially important. It helps you understand your annual revenue goal, so you know how many opportunities you need to create to reach that goal. You’re also able to assess whether your payer mix is shifting. Last year you might have seen 50% private pay and 50% managed care. Has that changed from the previous year? If it is shifting, how is that impacting your revenue and your opportunity creation goal? What do we need to change to make sure you can hit your goals for this year?

What are the most important things to know about thriving in an era of discount plans?

The most important things to know when trying to thrive in the era of discount plans is your current state of business. What is your current payer mix? What is your cost per unit? What is your margin per unit? What is your average selling price? What is your technology mix? Once you analyze this data, you can develop your strategy. You have three options to consider:

  1. If a patient is referred by managed care plan, you have to honor the referral, so that decision is made for you.
  2. If you discover the patient has access to a discount plan, you can make the decision to offer them the choice of going directly through you or going through their plan. Some plans do require you to go through them, but most of them don’t. In those situations, you need to decide if you’re going to explain the difference to the patient.
  3. You can decide to not let the patient know about the discount plan, because it’s not a true insurance benefit. Many practices only verify true insurance benefits, not discount plans. However, in this situation you do run the risk of the patient asking about it after the fact, so it may feel like a better option to be transparent upfront.

Triage on the front end is also very important. Getting accurate and up-to-date patient information can help you get a better picture of who is a managed care patient and who is a private pay patient.

What is an opportunity mindset? How can it help you succeed?

An opportunity mindset is where everyone in your practice knows how many opportunities are needed and everyone is hyper-focused on filling those opportunities. A good marketing plan is helpful, but an opportunity mindset is what takes your practice to the next level. A successful opportunity mindset includes looking out for existing patients that are ready to upgrade their hearing aids, making necessary outreach calls to cancellations and no-shows, tested not sold patients, out of warranty patients, patients pending medical clearance, prospect patients, and others.

There are endless ways that you can go about filling your schedule, but everyone needs to be focused on the goal to make that happen, and that’s what an opportunity mindset is all about.

How can you set your staff up for success?

To set your staff up for success, it’s important that everybody knows why you do what you do. Make sure that everyone believes in your mission. This means that having the right team around you is crucial. You need to communicate the goals for the year, set proper expectations, and let everyone on your team know what their role is in contributing to those goals. Lastly, hold everyone accountable to achieving your practice’s goals. This is easily accomplished is by implementing a daily huddle, as well as progress tracking. These are two key practices to make sure you’re set up for success.

As your ratio of managed care to private pay patients increases, it can feel increasingly difficult to reach your goals for your practice. However, by evaluating your current business, making crucial decisions about the managed care plans you work with, and aligning your staff on your goals, you can continue creating successful opportunities in your practice.

You’re not alone in trying to manage managed care. At CQ Partners, we’re here for you with the experience, knowledge, and resources to help you evaluate the state of your practice and make sure you’re equipped to handle the increase in managed care patients.


About the Author

Diana Dobo

Diana Dobo joined CQ Partners in 2011 as an Account Manager before being named Divisional Vice President, West in 2014. Since May 2018, she has served as Vice President, Strategic Accounts. Prior to joining CQ, Diana was a Senior Sales Manager in healthcare IT with Acusis and served as an adjunct faculty member for several colleges facilitating business courses. She has over 20 years of experience in sales, marketing, and business development and is passionate about helping her team and her customers achieve outstanding results.