tips for approaching negotiations with phis...final tips be firm but reasonable, and avoid emotive...
TRANSCRIPT
-
Privileged and Confidential1August 2017
Tips for approaching Negotiations
with PHIs
DHA Conference 2017
-
Privileged and Confidential2August 2017
What do your negotiations with PHIs look like?
-
Privileged and Confidential3August 2017
What you hope they’ll look like:
-
Privileged and Confidential4August 2017
The all-too-often reality:
-
Privileged and Confidential5August 2017
Just when you think you have a solid position:
-
Privileged and Confidential6August 2017
But in the end, nothing really changes:
-
Privileged and Confidential7August 2017
Know your business
What is the movement in your costs (labour costs, medical consumables)?
• Do you know how much indexation you need to neutralise your increase in cost?
• How do you measure your increase? △ cost per episode? △ cost per $ revenue
How has your casemix changed in the last 12 months?
• Make sure you seek increases where it matters
How is your casemix going to change in the next 12 months?
• Are you expecting to increase in a particular specialty or service?
• Is there a specialty or procedure type that you’re expecting to reduce/discontinue?
Approaching PHI Negotiations
-
Privileged and Confidential8August 2017
Know the available data
PHIO report- “State of the Health Funds” – ombudsman.gov.au
Private Health Insurance Quarterly Statistics – apra.gov.au
Private Health Data Bureau (PHDB) Annual Report – health.gov.au (hospital charges)
Hospital Casemix Protocol (HCP) Annual Report – health.gov.au (includes medical charges)
Approaching PHI Negotiations
-
Privileged and Confidential9August 2017
Show the PHI you know their business
Is their market share increasing or decreasing?
What was their premium increase for the year?
Ask them what their benefit outlay increase was for the year
Approaching PHI Negotiations
-
Privileged and Confidential10August 2017
Show the fund how your facility is delivering value for money
So your facility is delivering a higher standard of care… How can you prove it?
Show how your facility is drawing work away from other higher cost alternatives (large, long established inpatient facilities)
Approaching PHI Negotiations
-
Privileged and Confidential11August 2017
Straight indexation or line by line negotiation?
If the relative levels of rates are reasonable, negotiating a straight indexation can be a much simpler and shorter process (and the fund contract manager will thank you for it!)
If there are individual rates that must be addressed, then be clear about what you want to achieve and gather the evidence you need to back it up!
Approaching PHI Negotiations
-
Privileged and Confidential12August 2017
Watch outs
Multiple procedure rule changes
Reduction in some items in exchange for increases in others
Make sure you are accurately modelling the effect (% revenue change) of the proposed rates
Approaching PHI Negotiations
-
Privileged and Confidential13August 2017
Final tips
Be firm but reasonable, and avoid emotive language
Don’t gear up for a big fight on every negotiation
Remember - You’re in business for the long term. Building positive relationships with PHIs is always the best approach to take
Approaching PHI Negotiations
-
Privileged and Confidential14August 2017
Scott Bell Phone: 0414 686 073
Email: [email protected]
Contact
mailto:[email protected]