HFMA 2025 Recap, Part 2: Rethinking Payer Strategy & Price Transparency

Days two and three of the HFMA 2025 Annual Conference shifted focus toward how revenue professionals can best handle payer relationships.  Specifically, how providers can use data, negotiation strategy, and transparency tools to strengthen their financial position.

This second article in my three-article series represents what I, as a client partner specializing in the healthcare RCM space, gleaned from the conference as well as the recommendations I am passing along to my own Healthcare Provider customers.

Did you miss the first segment, focusing on using technology such as automation to prevent denials?  Read it here.

Want to continue the discussion? Schedule a chat with Seth.

Price Transparency: From Compliance to Strategy

Turquoise Health’s Joe Wisniewski outlined the evolution of price transparency, from static PDFs to dynamic contract intelligence in the session The New Reality of Contract Modeling and Negotiations. Providers are moving from compliance to strategy, using historical claims data and standardized pricing models to simulate contract scenarios and inform negotiations.

The real challenge now? Not setting the rate, but collecting on it. Health systems must ensure that contract terms translate into actual revenue, which requires close collaboration between finance, revenue cycle, and managed care teams.

On day three, this was doubled-down in the session Maximizing Leverage in Payer Negotiations with Payer Transparency Data.  Scott Ellsworth of Bon Secours Mercy Health emphasized a mindset shift: in many ways, the provider is the product. Health plans rely on provider networks to sell insurance. That gives providers real leverage - especially when backed by data, market dynamics, and community goodwill.

Successful negotiation, according to Ellsworth, starts early (ideally 12 months in advance), aligns executive leadership, and relies on data: reimbursement rates, days outstanding, payer mix, and pricing benchmarks. Without that foundation, negotiations tend to default to payer terms.

In the same session, Trek Health reinforced this with an AI-driven approach to contract benchmarking. By analyzing public datasets, their platform helps identify missed revenue opportunities and benchmark reimbursement rates across a provider’s service lines and market peers.

Bridging the Administrative Divide

A recurring theme across multiple sessions was the inefficiency caused by inconsistent payer processes, especially around prior authorizations and denials - and how this should be reflected in contract terms. Despite payers’ commitments to automate by 2027, providers still face fragmented workflows that negatively impacts revenue.

Liz Reyes from Elevance Health noted in her session Prescriptive Partnerships: Strategies to Reduce Payer-Provider Abrasion, that while payers focus on cost, providers must deal with operational fallout. Baptist Health shared how they reduced that disconnect by merging their Managed Care and Revenue Cycle teams—ensuring that contract terms were grounded in real-world operational impact.

And in Naples Community Hospital’s Spotlight Session (Turning Payor Challenges into Opportunities), they offered a case study in small-system leverage. Using managed care benchmarking, they identified up to 40% reimbursement gaps versus competitors. Strategic communication, backed by data and community impact, helped them secure better rates and terms.

My Takeaways: Strengthen Your Payer Strategy

1. Build a Data-Driven Negotiation Framework: Use price transparency, payer policy, and claims data to model negotiation outcomes and understand where you’re underpaid. Platforms like Trek Health can augment internal data.
2. Align Managed Care with Revenue Cycle: Silos hinder performance. Integrated teams can ensure contracts are not just competitive—but operationally executable.
3. Start Negotiations Early, with a Clear Plan: Develop a payer-specific playbook with internal alignment, external messaging, and fallback scenarios. Include board and executive sponsors.
4. Leverage All Points of Influence: Provider reputation, patient loyalty, and market scarcity are underutilized assets. Strategic communication—both public and private—can tip negotiations in your favor.
5. Standardize Where You Can: While payer variation remains, provider-side workflows should be as standardized as possible to minimize friction and administrative waste.

The payer landscape is shifting from adversarial to strategic, as long as providers are equipped to play the long game. With the right data, cross-functional alignment, and a clear negotiation roadmap, health systems can shift the balance of power, drive better reimbursement terms, and reduce administrative friction. Forward-looking organizations are using price transparency, payer intelligence, and poka-yoke standardization in their negotiation process to not only simply execute their future in-network contracts, but instead skillfully utilize their significant leverage to ensure right-revenue integrity.

Want to continue the discussion? Schedule a chat with Seth.