We're Not the Dark side: RevCycle from the Payor's Perspective - 2025 Fall Conference - HBMA Store

We're Not the Dark side: RevCycle from the Payor's Perspective Presented by Rachel Strauss and Madeline Smith

As presented at HBMA's 2025 Fall Conference October 6th-8th, 2025.

In this session, led by a health insurance plan architect and a pharmacy & J-Code savings strategist, we will challenge the common “dark side” label often associated with payors. By taking a closer look, we aim to dispel myths about payors as purely profit-driven entities and instead showcase a payor perspective focused on financial sustainability that ultimately benefits hospitals and patient care.

Key points include:

• Myth-Busting Payor Misconceptions: We’ll tackle the broad misconceptions around all payors, reframing the narrative to emphasize how financial sustainability aligns with supporting hospitals and enhancing patient outcomes.
• Enhancing Transparency and Trust: We’ll highlight the pivotal role of transparency in payor/hospital relationships, illustrating how proactive communication optimizes cash flow, improves service quality, and reduces administrative friction.
• Patient-Centered RevCycle: We’ll reveal how revenue cycle management on the payor side is designed to prioritize patient safety, affordability, and holistic care, reflecting a commitment to accessible, ethical healthcare that aligns with hospitals' patient-centered mission.
• Efficiencies for Financial Sustainability: We’ll share how payor strategies can streamline hospital administrative processes, cut down errors, and speed up reimbursements, supporting healthier hospital finances without sacrificing quality care.
• Driving Innovation through Partnerships: Finally, we’ll underscore the transformative potential of payor-hospital partnerships. From shared risk models to direct contracting and value-based payment structures, we’ll provide examples of collaborative initiatives that drive innovation and mutual success.

Learning Objectives
Course participants will be able to:

• Identify and challenge common misconceptions about payors and understand the positive role payors can play in supporting hospital financial health and patient care.
• Recognize the importance of transparency in payor-hospital relationships and learn practical strategies for fostering trust and improving communication.
• Understand the principles of patient-centered revenue cycle management and its impact on affordability, safety, and quality of care.
• Explore collaborative models such as shared risk, direct contracting, and value-based payment structures that drive innovation and mutual success between payors and hospitals.