As hospitals and health systems face increasing pressure to maintain margins and secure sustainable reimbursement, a growing number of leaders are turning to an old business truth: What gets measured, gets managed.
Payer “scorecards” are gaining traction as hospitals seek to hold insurers accountable, reduce administrative friction and strengthen their negotiating position. By systematically tracking performance metrics such as denial rates, response times and contract compliance, providers aim to shift the balance at the negotiating table.
“I often emphasize to my clients that data is their greatest leverage,” Brad Gingerich, vice president of payer strategy at Ensemble Health Partners, said during an episode of the Becker’s Healthcare Podcast. “One of the most important steps is proactively holding payers accountable. The moment a payer fails to meet its contractual KPIs, we flag it immediately — whether through formal demand letters or direct discussions.”
This strategy signals that any modification, however minor, will be carefully evaluated and challenged when appropriate.
Ensemble works with health systems to build proactive oversight into payer relationships — months ahead of contract negotiations. Using payer scorecards, his team quantifies friction points such as denials, response times and contract violations, often flagging missed KPIs in real time through formal demand letters or direct discussions.
“By the time we enter contract negotiations, we’ve already been tracking the payer’s performance for months, consistently raising concerns about denials, response times and administrative burdens in our monthly joint operating committee meetings,” he said. “We use payer scorecards to compare their responsiveness and performance metrics against competitors, quantifying every friction point throughout the process.”
These scorecards not only compare payers against competitors but also quantify the administrative burden and inefficiencies that drain provider resources. Market comparison data and transparency tools are layered in to make a compelling argument for better terms.
“It sets a precedent that even minor contractual changes will be scrutinized,” Mr. Gingerich said.
Health systems aren’t only using scorecards to evaluate insurers — they’re also turning the lens inward.
“Healthcare is simply too expensive. When you look at the broader cultural and societal impact, it’s clear that we need to find ways to make healthcare more affordable,” David Krajewski, executive vice president and CFO of Baltimore-based LifeBridge Health, told Becker’s. “To that end, we scorecard our Medicare and Medicare Advantage plans, and we won’t hesitate to cancel contracts with those exhibiting poor behavior.”
But the accountability cuts both ways and health systems need to also ensure that they are providing services in a cost-effective manner.
“For example, if we’re doing a total knee replacement across the entire episode of care, we need to assess whether we’re more expensive than other hospitals in the state. Having this kind of data gives us significant leverage in negotiations with payers,” Mr. Krajewski said. “If we find that we’re too expensive, we need to figure out why and address it. Ultimately, it’s about holding ourselves accountable and ensuring we are doing our part to keep costs down while maintaining quality care.”
He also emphasized the importance of clinician engagement — especially in Medicare Advantage contracts — noting that understanding prior authorization requirements and denial risks is critical to minimizing administrative hurdles.
At Grand Rapids, Mich.-based Corewell Health, which operates a large Medicare Advantage plan, payer scorecards serve a dual purpose: enforcing accountability and fostering collaboration. Even when there’s tension.
“While working internally is easier than working externally, we apply similar tactics in both contexts,” Corewell CFO Matthew Cox told Becker’s. “We prioritize sharing information openly. For instance, if we’re having trouble getting claims paid or facing issues with certain edits, we address those challenges together to reduce unnecessary friction.”
That said, he argues that sometimes friction is necessary.
“When I wear both a health plan hat and a hospital hat, I understand that some level of friction helps ensure we’re doing the right thing. It’s important to make sure that the proper processes are in place and that the right decisions are being made,” he said.
Corewell also contracts with Medicare Advantage plans from a variety of payers and use payer scorecards to track performance.
“Our situation might be different from that of a single critical access hospital, given our prominence in Michigan. But the underlying principle is the same: if we’re overturning 98% of denials, every denial represents wasted administrative costs” he said. “To address that, we use payer scorecards to demonstrate the problem and communicate that if these inefficiencies continue, we’ll need to adjust reimbursement rates to cover the extra costs incurred. We make it clear that these unnecessary hurdles yield no value.”
For Clay Ashdown, CFO of Salt Lake City-based Intermountain Health, payer scorecards are more than a metric — they’re a way to keep communication open and performance aligned.
“The creation of payer scorecards showcasing performance helps inform dialogue about why performance may be waning and what can be done on either side to improve,” Mr. Ashdown told Becker’s. He also sees scorecards as part of a broader effort to streamline front-end revenue cycle processes — reducing denial risk before claims are even submitted.
Whether used to confront poor performance, inform rate increases or enable strategic collaboration, payer scorecards are becoming essential tools in health system finance. For hospitals navigating complex payer relationships and increasing administrative burden, the message is clear: Accountability starts with visibility — and visibility starts with data.
