This episode of the MGMA Consultant's Corner Podcast features Doral Jacobsen, FACMPE, CEO of Prosper Beyond and an MGMA consultant based in Asheville, NC. MGMA podcast host and senior editor Daniel Williams sits with Jacobsen to discuss critical topics for medical practice leaders. She shares actionable insights on navigating the complexities of payer contracting while addressing disaster preparedness in the wake of Asheville's devastating flooding that resulted from Hurricane Helene.
Breaking Down Payer Contracting
Jacobsen's presentation at this past MGMA Leaders Conference, The Road to Successful Payer Contracting, highlighted the crucial steps practices must take to negotiate effectively. She broke the process into four actionable components: Readiness, Optimization, Addressing, and Delivery (ROAD).
“We tried to break it down into some digestible pieces,” she says. Jacobsen explains that this approach helps practices prepare, evaluate their negotiating positions, address contractual challenges, and communicate effectively with payers. Highlighting the need for understanding costs and the impact of contracts, she states, “One of the things that we're often telling our clients when we are setting out is how long it's going to take … It's better to really think through this as not a short process. Let's think about the long haul and let's zoom out.”
Navigating Transparency Data
Jacobsen addresses the use of transparency data in negotiations. While such data can provide insights, practices can often misuse or misunderstand its role. “I’ve got so many practices that are like, ‘Oh, I’ve got all this data. Now what do I do?’” she recounts. Jacobsen stresses the importance of context, explaining that practices need to align data with their fee-for-service models and negotiation timelines to make it actionable. Her advice is to not overwhelm payers with raw data, and instead to focus on clear, concise value propositions backed by relevant metrics.
Building Resilience in Negotiations
Jacobsen’s strategies extend beyond the technical aspects of negotiations to include behavioral approaches that help humanize and strengthen discussions. Simple actions, such as using humor or addressing people by name, can significantly impact outcomes. “We are all people just doing the best that we can,” Jacobsen remarks while sharing a recent example where a lighthearted conversation on a Zoom call helped establish rapport.
Practices can also bolster confidence by adopting empowering rituals. At her presentation, Jacobsen encouraged attendees to pick a theme song for negotiations. “If I'm feeling some sort of way and I need a little pick me up, I go to music. And so it boosts our confidence, and it just makes everything a little bit more fun,” she says.
The Role of Culture in Consulting
Cultural alignment is important when choosing a consultant for payer negotiations. As Jacobsen notes, “You’ve just got to make sure that you vibe with these people that are going to be helping you, because you can hurt relationships pretty easily.” Poor alignment can damage payer relationships, making it crucial to vet consultants thoroughly. She also highlights the value of experience and professionalism, noting “there’s a little bit of you get what you pay for” when it comes to consulting.
Jacobsen’s consulting philosophy revolves around being a translator who “speaks payer” and helps practices articulate their value. “It's such a sense of pride when we are able to move the needle for practices,” she says, adding how these successes create a sense of fulfillment.
Lessons from Disaster Preparedness
Jacobsen’s Asheville community recently faced severe flooding that caused widespread devastation. She notes how several practices were impacted, with one losing an entire office and another having multiple staff members lose their homes.
Reflecting on this crisis, she shares insights into how medical practices can prepare for and respond to disasters. Jacobsen highlights resources such as state medical societies and local networks that help practices relocate, support displaced staff, and continue operations. “From a preparedness perspective, I think it's kind of tapping into the resources (of) our local medical society … neighboring practices really kind of leaning on the community to find space where you can see patients, and then also finding ways to support individuals who are having issues with housing.”
Jacobsen praises the resilience of Asheville’s tight-knit community as it has come together to rebuild. She points to local disaster relief efforts as a source of inspiration and encourages MGMA members to support similar initiatives. For those interested, resources and donation links are available in the resource links below.
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