Niobis Queiro, interim chief revenue cycle officer at Nashville (Tenn.) General Hospital, said she believes both providers and payers want to give good care. The problem is payers also have a boss: the employers.
"So what we have started doing is talking to the payers and employers together and start talking about language, terms in the contracts," Ms. Queiro told the "Becker's Healthcare Podcast" during the 11th Annual Healthcare CEO + CFO Roundtable in November. "So that it is a win-win for the patient and also for us to be able to stay afloat because we're being reimbursed for the wonderful work that our physicians are delivering."
She said it is essential that employers educate themselves.
"One of the things that we saw was even in our own health insurance, when we started looking at the terms — being self-insured with the city — we noticed that the terms were terms that were made years in the past and never were changed to go along with the current care that is delivered today," Ms. Queiro said. And it had all these stipulations. So when we started clearing up the terms within the contract and educating those who are doing the actuarial work, it really changed our language and they understood how doing the correct care that goes with the chronic care model, that goes with the quadruple aim, actual delivers the results that they want and lessens the cost."