Outcomes and performance data are more valuable than process measures when negotiating with payers.
Emergency departments can negotiate from a place of strength when they’re backed up by relevant, high-quality data.
Beyond its use in the ongoing “AI-ification” of healthcare, data has become the driving force behind the quality and value-based direction healthcare has taken in the United States. Generally accepted estimates are that more than 30% of data created globally is from healthcare, at least 97% of which goes unused due to factors such as inefficient curation processes and data incompleteness.
It can’t be overstated that the quality of data has never been more important to the financial well-being of hospitals. However, considering that in 2022, more than half of all hospitals in the U.S. were reporting negative margins, many hospitals lack the internal teams or resources to capitalize on their unused data.
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The Traditional Dynamic: Price Takers, Not Partners
Hospitals often walk into contract negotiations with less data than payers, and that puts them at a disadvantage. Historically, payers have had broader visibility into population-level trends, risk scoring, and cost drivers, while hospitals have been limited to fragmented internal data. Without the ability to demonstrate evidence-based performance on diagnoses that matter to payers, even high-performing emergency departments are often forced to accept payer terms that don’t reflect their value.
That dynamic needs to shift. Not surprisingly, research is showing that hospitals can achieve greater bargaining power and more financially lucrative contracts, with data as the catalyst. And it is not just the volume of data; its quality and relevance are key attributes.
The Rise of Data-Backed Contracting
Payers come to the table armed with sophisticated analytics. To engage as equals, hospitals need more than access to data — they need data that’s curated, contextualized, and defensible. When EDs can present encounter-level analytics that are clinically vetted and relevant to payer population health goals, they can position themselves as partners and counter payer assumptions with evidence.
Instead of pleading for a rate bump, leadership can show, for example, that their sepsis bundle compliance outperforms national targets or that millions can be saved through reducing low-risk admissions.
How d2i Makes It Possible
Consider Emergency Care Specialists in Michigan. The group, which manages 15 EDs and had nearly half a million annual visits, used high-integrity analytics powered by d2i to analyze its chest pain pathway. The data showed that many patients could be safely discharged after rapid rule-out protocols.
By standardizing that approach, ECS reduced unnecessary admissions without impacting its financial outcomes. The approach effectively led to fewer inpatient days and zero increase in readmissions. Stakeholders were able to change the conversation from “you admit too much” to “we just saved your plan millions; let’s talk.” Evidence, backed by data, outweighs assumptions and paves the way to higher reimbursement.
This type of analytics requires reliable and clean high-quality data, the kind provided by d2i’s Emergency Medicine Performance Analytics. Through dashboards that executives can refresh before every contracting call, they can:
- Combine data from numerous origins into a single, validated source of information.
- Show validated and accurate risk adjustment.
- Demonstrate their performance on payer-relevant KPIs, including services utilization, readmissions, and managing members through lower-cost services.
Most importantly, high-fidelity data and associated ED analytics can help shift the culture inside a hospital. When physicians see their performance transparently benchmarked and tied to financial outcomes, they can engage in self-improvement that can serve as a lever for clinical excellence and make the next negotiation even stronger.
d2i will turn your data into negotiating capital, replacing defensive hindsight with incontrovertible evidence. Payers respect numbers; with the right analytics backed by high-quality data, providers can become their partners.
Start negotiating from a position your counterpart will respect. Illuminate your value with clarity and let your data speak the payer’s language. d2i’s Emergency Medicine Performance Analytics platform turns the flood of ED information into your most persuasive voice at the table, transforming contract talks from one-sided dictates to mutually profitable partnerships.
d2i isn’t just a data company. Our solutions were created to position emergency departments and health systems to excel into their future. When you are ready to change your negotiating dynamics, d2i stands ready to help. Book a meeting to see how our data and analytics platform can transform your clinical operations, strengthen your contracting position, and deliver tangible returns.