7 ways to tell that you need to add or drop a payer

Why This Topic Matters

Payer participation can affect revenue, scheduling, patient volume, and referral flow, so periodic review helps practices avoid underperforming contracts and missed opportunities.

Article Sections

1. Cost/benefit analysis

   Discusses how practices can compare payer economics and operational impact when reviewing network participation. The section frames payer performance in terms of overall business value and administrative burden.

2. Doing business with a payer is a hassle

   Covers nonfinancial signs that a payer relationship may be difficult to manage. The discussion centers on contract friction, denial burden, and workflow issues.

3. Payer mix is too concentrated

   Addresses the risks of relying too heavily on only a small number of payers. It explains why diversification of payer sources can matter for practice stability.

4. Patient exodus from one payer to another

   Describes how shifts in beneficiary behavior and payer competitiveness can affect patient volume. The section focuses on market movement and how it may influence network decisions.

5. Empty appointment slots

   Looks at schedule capacity as a factor in deciding whether to add more payer participation. It also discusses the relationship between patient volume, workload, and practice capacity.

6. You are out of the loop

   Explains how payer participation can influence relationships with neighboring providers and referral opportunities. The section notes that network alignment may affect access to patients and referrals.

7. Changing area demographics

   Reviews how community changes can alter payer and patient mix over time. The section considers broad demographic and economic shifts that may affect practice planning.