131: Your Managed Care Contract Called: It Wants a Raise

Your managed care contract called. It might be time for a raise. In this episode, Hannah is joined by Joe Russell, founder and CEO of YieldHealth, to unpack what home health agencies need to know about managed care contracts, payer negotiations, and the revenue (or terms) that may be hiding in plain sight. Joe explains why agencies are often underpaid by contract, not by accident, and why a payment is not necessarily the same thing as the right payment. They discuss how outdated rates, missed escalators, auto-renewals, underpayments, denials, and administrative requirements can quietly reduce an agency’s actual margin. You’ll learn: • The difference between your contracted rate and your realized rate• What to review first in your managed care contracts• How to build leverage before approaching a payer• Which quality and operational metrics matter during negotiations• Why smaller agencies can win through better terms, timing, and proof• How clinically integrated networks can give providers greater collective power If your managed care contracts have been sitting untouched for years, consider this your reminder to pull them out, check the dates, and do the math. Chapters (00:00:02) - Introduction and Guest Background(00:01:22) - Founding Yield Health(00:03:22) - Dog Talk and Personal Updates(00:04:59) - Denials, Authorizations, and Underpayment Roots(00:08:18) - When to Pursue Managed Care Contracts(00:10:49) - Data Providers Need for Negotiations(00:13:16) - Understanding Your Realized Rate vs Contracted Rate(00:14:53) - What to Review First in Your Contract(00:18:02) - Contract Terms: Escalators, Notice Windows, and Timely Filing(00:21:22) - Recoupment Timelines and Payment Delays(00:22:49) - Payers Playing Games and Power in Numbers(00:26:13) - Industry Shifts Toward Value-Based Care(00:30:43) - Where Provider Leverage Really Comes From(00:35:22) - Quality Metrics as Currency and Timing Strategy(00:37:38) - Payer Strategy: Regional vs National Plans(00:39:22) - What Yield Health Offers Clients(00:44:41) - Clinically Integrated Networks and Contact Info