Tips for creating a payer report card

Amid the flurry of pay-for-performance activity, a growing number of providers hope to develop tools to measure and monitor contract performance at the functional and operational levels of the organization. That’s where the payer report card comes in.

The payer report card is really a contract management system. Collecting all of the data and being able to stand back and look at the big picture gives providers more information and thus more leverage in negotiating their contracts with health plans.

Use the following tips to create your payer report card:

Developing a data warehouse is critical to creating your own payer report card. This involves taking data from several different systems and bringing them into a common platform—a data warehouse.

Compiling the data involves speaking with individual departments and holding joint meetings with department managers. This should then be followed up with a presentation about proposed data elements.

Once you’ve gathered the information, it can be sorted into two levels of report cards: functional and operational. Functional report cards are detailed and fairly complex. They are only necessary for high-volume payers (e.g., commercial and Medicaid). Operational report cards, which are more quantitative and objective than functional report cards, can be generated for potentially all contracted plans. Most of the information needed to produce these report cards can be pulled straight from the data warehouse.

About the Author

Reed Tinsley CPA

This article is written by Reed Tinsley, a Houston, TX-based CPA with over 30 years of experience advising physicians and medical practices across Texas and the United States. Reed holds certifications as a Certified Valuation Analyst (CVA), Certified Healthcare Business Consultant (CHBC), and Certified Financial Planner (CFP), specializing exclusively in the healthcare sector. He is a published author, nationally recognized speaker, and trusted advisor to physicians on accounting & tax, practice management, and financial planning. Schedule a Free Consultation.