1. First Steps to Success with Your Payers
R. Todd Welter, MS, CPC
R.T. Welter and Associates, Inc.

2. www.RTWelter.com info@RTWelter.com
Who is here??
2/27/2019

3. The Curriculum is coming
2/27/2019

4. www.RTWelter.com info@RTWelter.com
Payer?
Who is my customer?
Who is my customer’s customer?
My customer is my partner
2/27/2019

5. www.RTWelter.com info@RTWelter.com
The Big Picture
Full employment
PPO’s vs. HMO’s
Primary Care vs. Specialists
Aging population
Employers….we ain’t gonna take it anymore
2/27/2019

6. www.RTWelter.com info@RTWelter.com
What Does a Payer Need?
A network of providers which can produce
A network of providers who get it
A network of providers which they can sell!
Long term employer/customers
Volume! Members in large numbers
2/27/2019

7. www.RTWelter.com info@RTWelter.com
Ingredients
Comprehensive Preventative and Chronic Care
Sick care
Well care
Behavioral health
Patient Centered Medical Homes
Population Health Tools
Care Managers/Management/Patient Navigators
Predictive Modeling
Patient Registries
Financial analytics/Cost accounting
Risk based contracting
2/27/2019

8. www.RTWelter.com info@RTWelter.com
The Most Data Wins
Sample size 552,611 individuals
Top 50% of cost is 3.6% of the population
How is your data?
Lag
What is your universe?
Real time
Trends
2/27/2019

9. www.RTWelter.com info@RTWelter.com
PCP’s Know Yourself…
Who else can the payers use?
What is your capacity?
What is the payer’s potential patient base?
What are your patients needs?
What is your value?
What is your story…use your data to tell it
What is your (small PCP provider) to a payer. How can you use all this great data to show your value. Putting it to use
Use the data to tell your story. You want to tell the story of your patient, the payer wants to hear a story about the data
No is a request for information
2/27/2019

10. Specialists...Know Yourself
What is your overall cost of care?
Total case cost…use your data to prove it
Total case quality
Who do you utilize – secondary and tertiary referrals?
2/27/2019

11. www.RTWelter.com info@RTWelter.com
Value and Risk
Lowering the overall cost of care
Improve Outcomes
Prove it!
Measure it!
Manage it!
2/27/2019

12. www.RTWelter.com info@RTWelter.com
Data and Contracting
Data is king and knowledge is power
2/27/2019

13. www.RTWelter.com info@RTWelter.com
If you have it, use it…
What are you to a payer?
Data: Use it or lose it!
Use the data to tell your story
Providers want to tell the story of their patient…
The payer wants to hear a story about your data…
2/27/2019

14. www.RTWelter.com info@RTWelter.com
Don’t “Give It Away”!
2/27/2019

15. Data and Analytics Will WIN Every Time!
If you know how to use them…
The LAW of large numbers
Overall costs
Upside, downside…
PMPM for … what?
How do you affect outcome and how is it determined?
Global Risk
Partial Risk
Make this easier, general
2/27/2019

16. Contracting It’s the Never Ending Story
No is a request for more information!
2/27/2019

17. Questions? Thanks for coming!
2/27/2019