Securing in-network rate increases is crucial for the sustainability of your practice. We all got into the field to support families and help our clients make meaningful strides towards independence and support. We didn’t get into the field to become negotiators. Our job description didn’t include begging with insurance companies, getting rejected, and then having to turn down our colleagues who ask for raises. However, requesting rate increases is one of the top two most significant difference makers to our ability to provide quality care, invest in training, and manage ever-rising operational costs. We’ll delve into why rate increases matter and provide you with the four best strategies to help you secure those coveted double-digit in-network rate increases.

Why Do Rate Increases Matter?

You Need to Pay Your Therapists More

You can’t provide therapists with raises if you don’t get raises yourself. Cost of living keeps increasing and if they can’t make ends-meet, you’re going to see them leave. Can you blame them? No, but they will blame you.

You Need to Invest in Training

Ongoing training and professional development are crucial for adequately serving your families. Rate increases can supply the extra funds necessary to invest in non-billable training programs that benefit your therapy team.

All Your Other Costs Are Going Up

Running a strong clinical practice still comes with numerous overhead expenses. Rate increases help you keep pace with rising costs, ensuring that you can maintain the quality of care you provide.

You Need to Invest in Growth

Need another recruiter or an operations manager? Larger providers often negotiate for rate increases annually and invest in growth infrastructure. To grow similarly, your practice should aim for similar annual increases.

How to Secure Double-Digit In-Network Rate Increases

Text written on a paper that says get a raise!

Find the Right Person at the Payor and Get Friendly

Establishing a positive relationship with the right contact at the payor is crucial. Provider relations folks or manager level employees are trained to say no to rate increase requests. It’s typically their job to say no, so if the first person you speak to rejects your request, find the Director or another higher level person. These people will understand the implications of not supporting your partnership with them. Getting in front of that person is very difficult. Our recommendation is to seek out individuals who have previously worked for the payor or have expertise in payer negotiations that are trained to do so. The value of those consultants will certainly exceed their cost. We used James Craig and certainly recommend him!

You need to consistently ask for rate increases at a yearly cadence. Making rate increase requests yearly needs to become part of your practice’s playbook. It turns out that many payors have multiple fee schedules and start providers off on the lowest rung and push us up fee schedule tiers as we keep asking. Persistence is key to stacking up wins over time – your future self will thank you (though you may currently be kicking yourself that you didn’t do so sooner).

Use Health Transparency Data

Did you know that you can see what insurance companies are paying other ABA companies? Knowledge is power and leverage rates to support your rate increase requests. This ensures you know you’re not asking for too little or too much and knowing what all is fair. It’s incredibly difficult to read the machine readable files on each insurance company’s websites. You should consider paying a company like these who’ve already decoded it:

It turned out that the PE-backed companies had rates generally 20% higher than us. With one insurance plan, we found out that a few other ABA providers in our area were getting reimbursed 58% higher than us for 97153 (direct service)!

Understand Your Population-Level Outcomes

Highlight your practice’s positive outputs and how that helps the insurance plans’ members at scale. The key metrics that we’ve seen resonate are showing a systematic process of graduating clients from acute care and titrating down, reductions in severe behaviors over time, and increases in social and communication scores. Another important stat is sharing patient satisfaction scores and NPS results. With these data points in your toolkit, you may be able to skip one rung of the payor’s fee schedules and get those double digit increases. Christie Lau, our Director of Outcomes, put this all together for us and she can help you too! No pressure but here’s a link to her consulting practice.

Provide “Input Data” on Coverage, Cost Savings, and Speed to Care

You should understand that the #1 thing that insurance plans actually care about is how affordably you can serve a large number of their members. If you can show that you’re serving a meaningful percentage of a certain region, especially one underserved, you’ll have their attention. Therefore, figure out where they see the largest gaps in services. Work on solving that. Is it certain towns or neighborhoods that other ABA practices are not present in? Put together a map of your client locations and waitlist to showcase that your coverage area addresses their hard to support areas. Teamwork’s platform for matching and staffing will automatically do that for you.

A tentative map of waitlisted patients for Teamwork Healthcare

Highlight your practice’s efficiency by demonstrating speed to care metrics. Make your waitlist work to your advantage. Showcase how quickly you move families off your waitlist and match a behavioral team to them. Speed to care is very important for solving access and also clinically (earlier intervention). Teamwork’s matching platform highlights your staffing speed instantly so you can get improved rates for your efficiency. For our existing customers and ourselves, we staff our waitlist on average in a month, 5x faster than industry average.

Share data on care amount to illustrate the effectiveness for your services. If you want to make a powerful point, you’ll show that you deliver all those great outcomes you have while only using [X] hours per patient per week. If you don’t know what [X] is or how it compares to other ABA providers, then talk to Teamwork and we’ll help you define that with our analytics tools.

Teamwork's business health dashboard to show key metrics

Clearly define what sets your practice apart from the competition. Only you can define your team’s special connection to your patients. Do you drive strong outcomes because you’re culturally sensitive to certain patients’ backgrounds? Is it because of better training? Are you the only provider to support certain rural areas? Do you only employ PhDs? You need a story that explains why you’re unique and why you started as a provider. Within insurance companies, there are real people that will empathize and it will resonate with them. Once you find them, let them know why you wake up and go to work every day.

Conclusion

The hard truth is that rate increases become easier to get with growth and growth becomes easier with rate increases. It’s a virtuous cycle when it’s happening, but stagnation of either can feel miserable. While other costs keep increasing, it feels like you’re running on a treadmill and still falling further behind. How can you get either going and where do you start? Teamwork’s platform that helps with staffing, scheduling, and matching can be the spark that makes your existing team far more efficient and grows your practice without growing your overhead. We’ve grown census 3x since relying on our tech and customers typically grow their census 43% within 6 months of onboarding. We’ll also give you the analytics to show off your growth to leverage in rate negotiations. If you’re using Excel, that won’t solve your problems, but Teamwork can. See for yourself by scheduling a demo. Hopefully we’ll also be able to share more free advice on landing double-digit rate increases like we did!

Interested in Teamwork? Schedule a Demo!

At Teamwork,we pride ourselves on being different from our competition. Teamwork is built specifically for ABA providers with a focus on clinical quality. We automate manual work associated with scheduling (e.g. calculating commute times) so your team can focus on what’s important: delivering quality care to your patients.

Interested? Fill out the form below to sign-up for a demo of our tool!

The 4-Step Playbook to Secure Double-Digit In-Network Rate Increases for ABA Providers

Table of Contents