As healthcare margins tighten and value-based care gains ground, hospitals are navigating increasingly complex relationships with health plans. During a special session at Becker’s 13th Annual CEO + CFO Roundtable, industry leaders explored strategies for reducing friction, improving contract execution and building sustainable payer-provider partnerships.
Moderated by Joe Rafferty, managing director at Sellers Dorsey, the discussion featured Byron Glasgow, vice president of finance and payer contracting at Temple University Health System (Philadelphia), and Karen Brach, managing director at Sellers Dorsey. The session offered candid insights into the realities of value-based care readiness, Medicaid reimbursement pressures and the importance of operational alignment.
Here are four key takeaways from the session:
1. Outcomes, not just utilization, are driving the value conversation.
The shift from fee-for-service to value-based models is being accelerated by CMS and increasingly embraced by payers. Ms. Brach, who has held C-suite roles at several Medicaid managed care organizations, emphasized that future contracts must move beyond traditional utilization metrics to focus on measurable health outcomes.
“CMS has said, ‘We’ve waited long enough … we want to pay based on value, not based on volume,'” Ms. Brach said. “Historically, we focused on metrics like ED utilization or length of stay — but those aren’t outcomes. Going forward, outcomes are really what will drive the value discussion.”
2. Safety-net hospitals face structural barriers to assuming full risk.
Despite payer interest in shifting more accountability to providers, hospitals like Temple Health, where Medicaid covers the vast majority of births, are wary of full-risk arrangements. Mr. Glasgow cited a number of externalities — rising costs, policy changes — as key concerns.
“With all the current pressures, it is difficult for a hospital like mine with razor-thin margins to take full risk because there’s a lack of predictability around the medical loss ratio,” he said.
He advocated for payer-provider partnerships that include guardrails and gradual steps toward risk-based models, starting with upside-only incentives.
3. Transparency and testing can ease friction in contract implementation.
While contract terms often look strong on paper, panelists noted payer agreements are poorly executed due to administrative or technological barriers. “We’re all dependent on technology to make sure what we put down in 3,000 words can spit out a check or a direct deposit,” Ms. Brach said. She recommended that providers push for contract testing periods before implementation and request claims modeling when unique carve-outs are involved.
Mr. Glasgow echoed the need for clearer processes: “A lot of times, the people that are actually signing the contract aren’t that detailed with how the claims are processed — they don’t fully understand, so they sign something. It’s not intentional … but five to six months later they say, ‘Oh, by the way, none of these can get paid.'” He said adopting Medicare-based pricing benchmarks has helped reduce administrative disputes for Temple’s commercial payer contracts.
4. Joint operating committees can foster better alignment — if done right.
Operational issues such as denied claims, disposition day disputes and data mismatches often damage trust between payers and providers. To improve collaboration, the panel advocated for structured joint operating committees with clear ownership, prepared agendas and defined clinical and revenue cycle tracks.
“You need to have an owner at the payer and an owner at the provider that is going to make that meeting work,” Ms. Brach said. She suggested that health systems consider splitting committees into clinical and operational workstreams to make discussions more actionable.
Mr. Glasgow agreed, noting Temple is working to separate denial resolution from broader joint committee discussions to make both more effective.
