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5. Better rates for physicians
Whoever gets the docs wins, says Edwards. It's about the ability to steer membership to hospitals and out-patient facilities. If the hospital pays the doc then it gets the referral pattern.
6. Shifting market away from one payer
What would it take to accomplish this? Edwards says some narrow network deals may enable hospitals to drive business from one payer to another, but they aren't very common.
7. Better contract language with the largest payer
Hospitals are looking to improve the language that affects the timeliness and accuracy of payments, as well as the coverage of high cost drugs, carve outs, and medical devices. Edwards says he knows of hospitals that have refocused their negotiations with insurers from reimbursement rates to coverage issues. For example, they work to make sure they are reimbursed not just for a knee replacement procedure, but also for the knee implant itself.
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