How AI Can Help Negotiate Higher Payer Rates, with Brace Health

How AI Can Help Negotiate Higher Payer Rates, with Brace Health

A quick heads up for all the private practice owners who are reading. If you've been tuning in to the show for a while, you know that it took me at least ten years of grinding in my own clinics before I finally figured out how to scale and sell my 4 practices for 7 figures, and about 3 times the national average. The biggest shift wasn't some secret marketing hack. It was how I thought about profit, systems and my role as the owner. That's exactly what we're going to be working on together with you at the High-Performance Practice Conference in San Antonio, Texas from October 15th-17th.

Adam Robin and I are hosting a three-day hands-on event for PT, OT, speech, mental health, peds, pelvic floor, and medical practice owners who want to build clinics that are profitable, scalable, and best of all, don't depend on them 24/7. We’ll dig into simple profit and KPI frameworks, real leadership and culture work and practical systems you can take home and plug in with your team.

If you're doing roughly 6 to 7 low figures a year and you want your client to feel more like a real business and less like a job/cage, I'd love to see you there. Frankly, I'd love to see you bring your leadership teams as well because we will have breakout sessions for them, too. You can get all the details and grab your seat at the link. Let's get into our episode.

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I have with me David O'Hara of Brace Health, an AI-native billing services company. David and I have been working a little bit together on a new free payer negotiations program. Since we just talked about it with Adam on the call, I thought I'd bring on David and talk about it as well. First of all, David thanks for joining.

Thank you for having me. Excited to be here.

I'd love your perspective because you've been doing some pair negotiations with PT companies. Have you been working with others besides PT?

PT, OT, speech and dietician. I'm in the four so far. I'm chiropractic, so five.

Tell me, you've had some experience. You've been doing it for how long? A little under a year?

The negotiations started about a year ago but it picked up months ago. We've got several hundred under our belt now. I’m excited to share a little bit about what's working and what's not working.

Tell me right off the bat. I'm inclined to just contextualize this. If you read the previous episode that Adam and I did about increasing profitability and possibly negotiating with payers, I'm a little bit more inclined to drop the lowest payers. We know who those chronically are. Sometimes the time and effort that it takes to get an extra $2, $3 or $5 per visit isn't necessarily worth it, nor does it make up for some of the administrative headaches that those lower payers can put you up against. You tell me from your perspective now you are the boots on the ground. You've done this a number of times like you said, is it worth it? Are you seeing it being worth an owner's time to go through the process of asking for more money from these insurance companies?

Why Small Rate Bumps Yield Massive Annual Profits 

The short answer is yes and I don't disagree with what you're suggesting. We've done 100 of these negotiations mostly for practices in the 1 to 5 location mix. These are not the large enterprises. These are for the smaller practices. About 35% of the practices we work with are able to get at least one rate increase. That's usually in like the 5% to 10% range. That's the first point of, is it going to fundamentally change economics? Unlikely, given what Nathan has been suggesting but it can be meaningful. You can imagine $5 extra, 200 visits a month. That's $15,000 a year. That can be from just one email. It is worth it. Sometimes, it's a little more than one email but it is worth it and it is working.

If people want to check out some of the specifics they can go to BraceHealth.com/Nathan to see what some of the other testimonials might have to say and what is all offered and even get on the wait list to see if they can help you out. Check that out so you get more details there. What I'm wondering, though, where would you recommend owners start then? If you and I are both in agreement that maybe some of those low payers you just don't mess with, are you looking at some of the payers that have a higher census in the clinic? Are those the ones you recommend initially or do you start simply with a lower payer and work your way up?

Targeting High-Volume Payers For Immediate Impact 

What's counterintuitive is an interesting insight that we found early on is that some of the highest paying payers are often the ones most willing to negotiate. A lot of times. it's like, “Let me start with the low payers and then go to the high payers.’ I would more start on what payers matter most to you in terms of patient volumes because that's where you're going to get your biggest bang for the buck. There's some that I would immediately take off the list like Medicare, state Medicaid.

If you don't own the contract like if there's some central body, you doing individual negotiating is not going to do anything. A lot of the commercials, a lot of the workers' comp, we've had wins with some of the large nationals and a lot of the smaller regionals. It starts with the payer mix in terms of where to spend the time, then it's going into, what they care about, which we can talk about more. It's starting with which payers matter the most for your practice.

That is the question. What moves the needle with some of these payers for them to be willing to negotiate with you? Have you seen certain talking points that make a difference and sway them one way or another and what might those be?

That's basically where this started. We talked to a number of owners and it was something like less than 20% of them had ever tried. The answer was, 1) I don't know what to say. 2) I don't know who to say it to. 3) It's probably not worth my time to figure that out. To start this off, we did a bunch of research on what payers care about. We read white papers, watched YouTube videos and had AI ingest all of this. We brought this to a handful of practices who had successfully negotiated, especially some of the larger ones, then we brought it to payers directly.

We created this framework that we now have been using. The first set of negotiations we did 10 and 4 had increases. We said, “Maybe there is something here that we should get to.” I'll share our perspective on it but the major caveat is, we are new to this. We've only been doing this for a year. We don't consider ourselves like the end-all be-all experts.

You have a lot more experience than most everyone that's reading.

We do have a few hundred instances that we can start to draw some patterns from. What you're also going to hear is, I'll come across as cynical and negative about payers but I hope it comes across mostly as realistic. At the highest level, what payers deal in is incentives and leverage. Incentives are, what does the payer care about and leverage is, what can you credibly do or credibly threaten to do that impacts what the payers care about. What a lot of practices start with is their own margin pressure, staffing costs, inflation, the long term value of PT, and arguments that are like, “We deserve more.”

Unlocking Leverage Through Network Adequacy 

That's all true, but this doesn't influence payers on their own. You have to ask what do payers care about? It's two things. One is network adequacy. Employers are the payer’s real customer. Employers judge their plans based on access. Can my employees access care when they need it? When that access breaks down, payers feel pressure and that's what creates complaints, regulatory scrutiny, etc.

We've seen this over the years in mental health. There was a huge demand from employees saying to their employers, “I need access to mental health.” It gave mental health providers lots of leverage and they were able to secure much higher rates. Number one, it's about network adequacy. I'll talk about why that's a hard argument to make because of what they believe but that's the first theme. The second one is near term cost control.

The surprising statistic is that the average commercially insured member stays on their plan for less than 24 months. If you try to make an argument to a payer that is like, “I can reduce costs in a 3 to 5-year time period.” They say, “That doesn't help me because these members are going to churn before that happens.” We stem all of our arguments into one of those two, either you're going to solve employer complaints and a network adequacy problem or you're going to immediately reduce near term costs. I can describe what are the arguments that work within each of those if you want to go into that.

I do want to go into that. Let me ask one more question because I know there's plenty of studies that show getting physical therapy early on, especially in musculoskeletal cases. I can't speak the same for OT and speech. I'm sorry guys who are reading. In the PT world, how it saves the healthcare dollar the sooner the patient gets in for physical therapy instead of going through the primary care route. Does that carry any weight at all? Do they care? Maybe they don't. Have you tried that? What have you found?

Again, just one perspective here. They know that. There are so many studies out there. When you just reiterate that point to them, this isn't new information for the strategy folks at these organizations. They know that information. What's unique is your specific network importance. That's like more local regional niche specialty specific that you can make an argument about or it's your ability to impact their near term costs.

That comes down to like are there other care pathways that are going to be more expensive that patients will opt into if you are not in network with them. We try to make it more localized specific to the practice because there's lots of outcome data. It shows all of the impact that can have on the healthcare system more broadly we know that but from our experience, that's not what is going to get the attention of that network manager whose job is just, “Make sure I have enough network adequacy so I don't get yelled at by my boss when we lose an employer contract because I haven't managed the network well enough.”

Tell me how you leverage AI to help owners with the network adequacy problem and also how it improves financial outcomes for the benefit of the payer.

On the network adequacy side, unfortunately, most payers believe they have enough PT. The job is to prove that they don't without you. The general positioning is like, if we left your network some of your members would lose critical access to care. The arguments that we typically try to make are geographic scarcity. We're the only one in this zip code or this town, usually some clinical specialization. The one that seems to get the most traction is pediatric, pelvic and neuro.

Those are the ones that generally get reactions. Now operational access is also a form of network adequacy where maybe you're in an area that has a lot of night shift workers and you're open 5:00 to 8:00 AM. That's a form of access that folks would lose if you weren't there. Many practice owners know this argument already. They know their local networks. You don't necessarily need the AI.

Using Local Market Data To Expose Hidden Scarcity 

What the AI allows us to do is we go on Google Maps and we look at what are all the practices nearby and what's unique about what you're doing, where is their traffic and then what is that best argument from a network adequacy perspective. We do the same thing on the near-term cost increases. We're going to look, are there local hospitals or hospital affiliated groups that if you went out of network that's where patients are going to go? Not only do we all know that PT visits are 2 to 4 times more expensive when they go to a hospital or a hospital affiliated practice.

Also, health system care also pulls in imaging, specialist referrals, diagnostics, and sometimes earlier unnecessarily. A single MRI is 6 to 10 PT visits. We try to make that case like patients driving along this road. If we are out of network, they're going to take a left at this turn and they're going right to this hospital group. That's where you're going to start to see your costs increase. Again, it's trying to use this technology to get local to, “This is the value that I bring.”

You focus on those two things as super important. There are the general strains that most owners have noticed in terms of increase in salaries especially for providers and the inflationary costs over the past six years especially. Do you still mention those towards the bottom? On top of all this, we still are with this or do you just leave that out?

We add them as credibility to the threat of going out of network.

This is why we need to go out of network.

It's like, this isn't just a letter. This isn't just a phone call. We have actual structural reasons why this is challenging for us. We also use patient reviews in the same way where we say, “Our patients love us. Look at our Google reviews. Look at our NPS.” They are very frustrated with their employer. They might still come to us and use out-of-network benefits and again be frustrated at their employer. We try to use those as credibility, it's a real risk that we go out of network as opposed to an argument in itself.

Very cool. We covered a lot of the details that go into that initial letter. Is there anything else that we're missing that we haven't covered?

What I often hear is a lot of debate around what to ask for. In my opinion is, it's very tempting to ask for a broad set of changes, authorizations, expanded visit limits, direct access, and pilots. These are all great ideas. Our experience is that it's best to just ask for rates as a starting point for a couple of reasons. One, those other things are more plan design. Plan design takes a lot more time often than rates. It also usually involves multiple decision makers.

We're dealing with network managers, contract managers who have a very specific remit, which is to manage the network. They might have one lever to increase rates. Many of them don't. We tell practice owners, “This isn't a silver bullet. You might get all the rejections.” If they do have that lever, we're going to make that best case on their behalf.

Once you start to introduce other asks, it can dilute the communication funnel. You're going to a slightly different part of the organization. It doesn't mean as an industry we stop pushing for it. We should. There's a real place for this work, but I don't think of it as an individual practice with limited time and leverage. I'd be pretty honed in on what the specific rates that I can get. If you don't get them, follow Nathan's advice. Let's cut those low payers.

I'm glad you brought up rates because that was an obvious miss on my point. You got to ask for the money. What then determines the ask that you have? Is that part of the support that Brace Health provides? You and I both know that most owners reading I would say don't know their cost per visit, based on my experience. I'm willing to say 51% at least don't know the cost per visit.

They might know a general range of their reimbursement per visit but I'm assuming that the program looks at the financial data to say, “This is what X, Y, and Z insurance is paying you per visit in the past trailing six to twelve months.” You also need to know your cost per visit. Do you pick an arbitrary number to shoot for? Is that a calculated number that you're asking for when you ask for an increase?

Asking For Bold Percentage Increases Upfront 

I have yet to hear any feedback or have any specific data that would suggest there's a better approach than an arbitrary number. What we generally do is ask for a large percentage increase. It's a mechanism of the ask with the rationale. It's like your charges versus the allowed amounts. It doesn't matter what you charge. They're going to pay you the allowed amounts. We usually put in like smaller asks, 10% or 15% asks.

We found some payers would match those. We were like, “That means we didn't ask for enough.” Now, a lot of the time, we come out the gate and say, “We need a 50% increase.” We have yet to have someone say, “No because the ask is so high.” We haven't had that feedback quite yet. At a minimum, aligned with your highest payer but I also wouldn't constrain yourself to just the highest payer because I would also make an argument that they're underpaying you too.

Exactly. That's a good point because it almost doesn't matter what you throw out there at first. You're just trying to start the conversation.

What flies slightly in the face of everything I've just shared is there also is an argument that what you ask for doesn't matter at all. The arguments don't matter. What matters is who you make the ask to and just making the ask.

That was going to be my next question. How do you determine who to send this letter to? You might just generically think of the customers or the provider service representative or something but no. I did an interview a few years ago with Trace Kennemore in Tennessee. It took him three months to find the right person in his regional United healthcare administration to talk to. There was one person over United healthcare and for his particular region.

Bypassing Generic Gatekeepers To Reach True Decision Makers 

We now have that UnitedHealthcare person for every region in the country but it has taken us so much effort to find. We're looking for a network manager, a provider contracting manager, a network development manager. You usually have to either call or email some generic line. You get forwarded six different times.

You get to the wrong person. We've spent an enormous amount of time building this contact database that we're constantly trimming and improving so that you can know very quickly like, “If you're in this state dealing with this payer, this is who you speak with.” For states that we haven't worked in we offered as part of this free program with you Nathan. We will go out and do that work for you.

We are making phone calls. We are sending emails. We're on LinkedIn doing everything we can to find that person but it's often very difficult to find that person. That's the one area that I certainly understand why practice owners are not going after because it's like these big monoliths like, “How am I going to find that individual?”

It's not easy to negotiate that. That's the one thing I like about your program is you are building out this database. You are a year into it but you're still building the database so that you can have all that contact information and a data set behind what they're willing to pay that makes a difference across the nation state by state. 

Once you start to introduce other asks, it can dilute the communication funnel. You're going to a slightly different part of the organization. It doesn't mean as an industry we stop pushing for it. We should. There's a real place for this work, but I don't think of it as an individual practice with limited time and leverage. I'd be pretty honed in on what the specific rates that I can get. If you don't get them, follow Nathan's advice. Let's cut those low payers.

I'm glad you brought up rates because that was an obvious miss on my point. You got to ask for the money. What then determines the ask that you have? Is that part of the support that Brace Health provides? You and I both know that most owners reading I would say don't know their cost per visit, based on my experience. I'm willing to say 51% at least don't know the cost per visit.

They might know a general range of their reimbursement per visit but I'm assuming that the program looks at the financial data to say, “This is what X, Y, and Z insurance is paying you per visit in the past trailing six to twelve months.” You also need to know your cost per visit. Do you pick an arbitrary number to shoot for? Is that a calculated number that you're asking for when you ask for an increase?

I have yet to hear any feedback or have any specific data that would suggest there's a better approach than an arbitrary number. What we generally do is ask for a large percentage increase. It's a mechanism of the ask with the rationale. It's like your charges versus the allowed amounts. It doesn't matter what you charge. They're going to pay you the allowed amounts. We usually put in like smaller asks, 10% or 15% asks.

We found some payers would match those. We were like, “That means we didn't ask for enough.” Now, a lot of the time, we come out the gate and say, “We need a 50% increase.” We have yet to have someone say, “No because the ask is so high.” We haven't had that feedback quite yet. At a minimum, aligned with your highest payer but I also wouldn't constrain yourself to just the highest payer because I would also make an argument that they're underpaying you too.

Exactly. That's a good point because it almost doesn't matter what you throw out there at first. You're just trying to start the conversation.

What flies slightly in the face of everything I've just shared is there also is an argument that what you ask for doesn't matter at all. The arguments don't matter. What matters is who you make the ask to and just making the ask.

That was going to be my next question. How do you determine who to send this letter to? You might just generically think of the customers or the provider service representative or something but no. I did an interview a few years ago with Trace Kennemore in Tennessee. It took him three months to find the right person in his regional United healthcare administration to talk to. There was one person over United healthcare and for his particular region.

We now have that UnitedHealthcare person for every region in the country but it has taken us so much effort to find. We're looking for a network manager, a provider contracting manager, a network development manager. You usually have to either call or email some generic line. You get forwarded six different times.

You get to the wrong person. We've spent an enormous amount of time building this contact database that we're constantly trimming and improving so that you can know very quickly like, “If you're in this state dealing with this payer, this is who you speak with.” For states that we haven't worked in we offered as part of this free program with you Nathan. We will go out and do that work for you.

We are making phone calls. We are sending emails. We're on LinkedIn doing everything we can to find that person but it's often very difficult to find that person. That's the one area that I certainly understand why practice owners are not going after because it's like these big monoliths like, “How am I going to find that individual?”

It's not easy to negotiate that. That's the one thing I like about your program is you are building out this database. You are a year into it but you're still building the database so that you can have all that contact information and a data set behind what they're willing to pay that makes a difference across the nation state by state.

Once we find that person, they're not an adversary. If you can find the right person, they're just a decision maker with a set of incentives and they want to remain employed and do a good job at work. I often think of it as, “How can you help them promote it?” A lot of these conversations are not necessarily adversarial because you end up finding this person who's responsible for managing the network of physical therapy, rehab therapy in a certain area.

You are trying to tell them like, “There's something you're missing. Let me help make your job better, make you more effective at what you're doing if you can get to that right person.” It's just hard to get there. If that doesn't work, we have a series of escalation tactics that we recommend that can be useful or we've seen varying uses of them.

Through the program, you gather all this information. You generate the proper negotiation form and who to send it to. Owners send this off on their own behalf. You don't do it for them. You just do all this background work for them so they can copy and paste and then send it off. Once they do that, two questions. What are the follow ups look like? What time frames are you seeing communication finally come through?

Mastering The Art Of Relentless Follow-Up Outreach 

They typically start with either an email or a phone call. That's the standard route. What we encourage is follow ups until you receive a no. We had a negotiation in the Southeast US. It took eleven follow up emails to the same individual. No responses for all eleven emails.

I would have given up after like three.

They gave a 10% bump. It's not that time consuming. You’re sending an email that says, “Following up.” All you're doing is just putting it at the top of their inbox again. A couple like tactical pieces of advice. Number one, if you get a response, don't take the first offer. If they're willing to give you an increase, they might be willing to give you a higher increase. We have yet to see someone get their increase taken off the table because they asked for more.

If you don't get the increase, what a lot of practices do is, they'll say, “Please send over the paperwork required for us to terminate our in-network agreement.” That can trigger internal routing because it signals that you're more serious about leaving the network. That's often a common path. There are more aggressive paths where we have had practices draft letters to patients explaining that they are forced to go out of network because rates are unsustainable.

Encouraging them to bring that to their HR departments, especially in areas where there's large employers that drive most of it. Some will even say they're going to bring that to the local media. You don't want to be overtly threatening to payers. That's not the right tone to take. Again, thinking about like, what do they care about? What are they worried about? How can I engage with them on that?

Is there a sweet spot as to when negotiations finally become successful? Does it vary across the board? I'm assuming it's going to take at least 90 days but it could extend out to 6 months to 12 months.

The uninspiring answer here is it varies. We have a payer in the Northeast that is one email. They'll respond in two days and they'll give you a 25% bump every time. We've had 25 plus wins with that payer. We have some payers that we've been sending follow-up emails for six months and haven't received a response. If there was an average, probably in the 60 to 90 days, but a lot of that work is typically like finding the right person. The faster you can get to the right person the faster we can have it turn around. It's not like hours and hours of work over 60 to 90 days. It's usually just follow-up emails and a few calls to get there.

That's the cool thing about your program is once an owner submits the information. You're doing a lot of the background work and then it's copy-paste and send an email. Maybe a reminder three weeks later to copy-paste another email, that thing over and over again, which saves the owner a ton of time and effort.

I had an owner in. She's been super successful with like a dozen payers asking for increases. Interestingly, she said she did all of her work through email. She didn't have to get on a single phone call. She referenced How to Win Friends and Influence People. Those tactics are to be nice to people and get on a first name basis, remember their names and then ask other questions that show that you're interested. It’s super helpful. You mentioned phone calls. Are there times in which you recommend a phone call? Do you simply focus on emails most of the time?

I would agree most of our interactions are emails, which again lowers the barrier. There are some where you're required to get on a call or either a phone call or a Zoom to make your case verbally. In which case, we tell our practices, “Open your letter and just read it,” but I definitely agree. What we have seen is that's what I was saying about the adversary. If you can become friends with the network manager it does help because they have to internally be able to defend the case that they're making. Folks are more likely to go out on a limb and stick their neck out there for someone that they are just like as an individual or they believe in the work that they're doing. I do think that matters.

How have you seen this affect the owners that are doing it? Not all of them are successful. Some of them are, but have you seen a change in attitude or character related to how they perceive the insurance payers or frankly in their ability to approach them?

It's been a couple of things. One is it certainly creates a sense of relief that they have taken this off their to-do list because for years they’re saying, “I should be doing that.” Now, you can say confidently, “I have a great letter and I've used the best contacts that can be found. I can at least check it off my list.” For those that have received increases, the financial impact is substantial because it's straight to the bottom line.

This is just an immediate increase in profits, an increase in dollars per visit times the number of visits. There's a financial strength to it, but then there is some element of control that owners feel like, “I can negotiate and potentially win? It's no longer like I'm stuck in this system and there's nothing I can do about it?” I have seen it emboldens practice owners to do things like go out of network and drop certain payers because they're like, “I have an agency here. I can take action.”

That's been great. Maybe the last one to add is, I view this as a form of advocacy for the industry. Each request documents reimbursement and access pressures. It makes practice concerns more visible. There are payers that when they respond to us, they're like, “I didn't know. I haven't thought of my pelvic network before.” There is a version of getting it out there, by sending these letters like we are supporting the entire industry. I do think that these individual requests can influence broader behavior. This is something every practice owner does. You negotiate your rates every one or two years with some emails and some follow ups and you can get what you deserve.

I like what you said about how that can help the industry because I'm sitting here thinking if owners are quiet about this and they're too busy or they don't have the time or don't have the energy to do a lot of this. It's quiet on the payer network person who negotiates all these contracts. If she's not she or he's not hearing from the owners on a regular basis, then they're just thinking everything's hunky dory.

Everyone’s happy with their reimbursements and I can just focus on this other area. Whereas, if they were flooded with a bunch of negotiation requests, now they're saying, “Maybe there's a problem here. Maybe there is a concern that I need to be aware of.” At that point, it's like the squeaky wheel gets the grease. If everyone's quiet, then that doesn't do any benefit for us as an industry.

I can't draw an exact causation or correlation here but we have had some payers where we have sent 25 to 30 letters to the same contact. We have seen, at least for one payer I know of certainly, that at the beginning of receiving the letters we were getting consistent no's and now we are getting consistent yes's. I do think that the pressure of all of these practices sharing independently. This isn't a collusion effort. I know folks are afraid of that word. This is just a tool that you can use to write a letter and send an email.

This isn't like some coordinated effort but when enough people send an email saying, “I'm dissatisfied,” which is simply an accurate reflection of the sentiment of practice owners. This isn't some like concocted game plan. Let them know your value. Let them know your frustration. It's beneficial for practice owners across the industry.

Can I express one concern and you can shoot it down?

Yes.

You're leveraging AI and leveraging also a lot of the same information no matter where there might be. If you're going to the same payer and in the same templated format of a letter, are the payers getting close to that and thinking, “This is just another letter that Brace Health helped X, Y, and Z owner create?”

We've talked about this internally. Each letter is quite different because it's specific to the practice. No argument is the same. It's very much tailored to the specific practice that we're working with. We have also started adjusting the formats so they look like different letters. They're so well written that most people now would say AI probably helped with that.



Whether or not they're using the Brace Health tool or not. We've sent dozens of letters to the same individuals, we've yet to hear. At the end of the day, you're just making a case and saying you're threatening to go out of network. Even if AI helped you with that, that's the fact of the matter. They have to respond to the statements that you're making.

How do you recommend Brace Health get started? Are there some metrics or reports that you recommend owners be better aware of for their individual practices as they start this process? I brought up their cost per visit as a key performance indicator that they should know if they're going to go into some negotiation. Are there reports or KPIs they recommend? I know some of those, you're going to ask them to upload and share with you so you can provide the appropriate information.

We don't ask for any of the information. We don't ask for rates because that's all information that you will share. We just suggest a percentage increase request. We don't necessarily gather that information.

You're not necessarily gathering saying, “You guys are currently paying me this amount. We recommend it go up 50%.” You're not even working off that. That's interesting. It can vary so much.

It can vary a lot. Also, I don't think it necessarily helps the case. Where you specifically are, that's information the payer knows and has. What they might not understand is what is the specific value that you bring. In terms of what I would gather before engaging, it is your payer mix. The volume you have for each of these payers, you get a general sense for that.

What are the specialties that you are offering that others are not offering? You can go on Google Maps and see this or we can look it up for you. Anything that would make your practice specifically unique to a payer is what we encourage to collect. We usually don't gather anything around practical operational metrics or rates at first that we usually just say give us some context on your practice and we'll write a letter for you.

I'm assuming when you send follow up letters or counter offers, you have a method to that madness as well.

Not as much. You make the ask for some increase like we talked about. We usually shoot for something like 50% just so we don't cap ourselves. When they come back with a response, it's either a no or it's an increase by a certain percentage. It's linear from there. It's less scientific. The decision of whether you accept it goes to what you're describing around cost per visit. Let's say they're paying you $75 a visit and you're able to negotiate up to $85. That's an exciting 12% to 13% increase. If your cost per visit is $91, you're losing money.

Unless you're in network with that payer for some mission-oriented reason or you're trying to drive patient volumes, it would make sense to reduce, especially if you have a wait list. You should be cutting that payer. What you're suggesting is probably a sophistication level that we haven't found to be necessary quite yet. It's just, make the ask and make it to the right person. That's what we've seen to be the results but we're still early. We hope to send thousands of these letters. We only send a few hundred at this point.

For sure. If people go to BraceHealth.com/Nathan to sign up on the wait list and become a part of the free program. Do they need to have any reports ready? Do you ask them for any specific information that they need to be prepared to upload?

It will be a five-minute survey that you could probably do on your phone as you're walking. It's a very light touch. We used to have a longer intake process. Again, that's just adding to the burden of doing this. If you go to BraceHealth.com/Nathan you'll get in because of your referral from Nathan and we'll get you that initial survey. It will take five minutes to fill out, then you'll get a letter, an email to send and then the specific contacts at the payers that you're in network with. You just copy and paste and you're on your way.

Do you also do a short consultation with them during part of that process?

I'll usually meet with them as a way to share something like, “This is our understanding of the best arguments for your practice.” We usually talk about if they've done anything in the past as well as set general expectations. There's some things that it's just better to talk through, “We're working with United here. We've worked with this individual several times. This is what she's like and this is what she cares about.” Some of that is more like an experience we’ll usually share. We'll do a five-minute survey, send you some information and a ten-minute call with me to give you a sense for what to expect and then that's it.

You guys are an outsourced billing services company. How did you get into this little niche of negotiations?

It started by just looking at our own customers' rates. We were like, “These are very low for some of these payers. Have you tried negotiating?” They shared, “Not yet.” As a team of software engineers building AI agents for making sure you get paid what you deserve. Could we increase what you deserve? It was the question. We built this side tool. As I said, we did those ten initial negotiations. We had four come back. We expanded that to be a little bit larger. We saw that 35% hit rate and said maybe there's something here. We have an exclusive partnership with Nathan to get this in the hands of some practice owners.

In time, we will probably charge for this or it's a product that we will offer. It's something that we'll just offer for our own customers on an annual basis. For now, we're still trying to figure out what works and what doesn't work. Gather that national database that I've been talking about. That's the stage we're in. It's a great price if you come through with Nathan. That might change over time.

That's right. You focus a lot on leveraging AI for this program. It sounds like you're doing a lot of AI integration into the billing and collection services that you provide as well. I'm sure you're making great strides in that regard.

It's an amazing time to be building AI technology. What we've seen is the ability to increase on the billing side practices revenue 2%, 3%, 4%, or 5% without switching EMRs by having each practice we work with gets a dedicated US biller and a fleet of these AI agents that are making phone calls, checking portals, writing appeals letters. You can imagine. When you hire us, you're hiring one US-based human and a thousand of these AI agents that are going to incessantly follow up to make sure you get paid what is needed. We see that as like an extension of the work. Our ultimate mission is to strengthen private practices. That's what we're going towards.

That's super cool because I can easily see the connection between these letters that you're sending out for increasing reimbursement rates and appeals letters and dealing with insurance companies on a regular basis. You and I both know that the insurance companies are using a ton of AI agents. If we're not combating the same, then we're bringing a bunch of slings to a gunfight.

It's exactly right. It's not a fair battle. We need to at least even the playing field with some of the technology that we're building. Especially as payers do more and more deny, delay, and underpay. It's something like 4% of denials get appealed and then 60% of the appeals get overturned. We need to be much more on top of like, were we underpaid? Did we get paid what we expected?

It's not possible for a human to do. I started as a human. I was a biller for a handful of practices. That's how I learned. I was missing things left right and center. When you're dealing with thousands of claims in a month, you're not going to be able to see all these issues. AI won't make those same mistakes. They will catch everything and they will follow up aggressively to make sure you get paid.

People can go to BraceHealth.com/Nathan for the free program. If they wanted to talk to you about outsourced billing services, how can they get in touch with you guys?

Shoot me an email at David@BraceHealth.com. I am quite responsive to email so you can get to me directly there or you can go to our website. We got a quick form on there to indicate your interest and I'll give you a call usually within a few minutes. I'm violently responsive to my phone so give me an email. Feel free to reach out in either one of those ways. Thank you, Nathan, for the time. As a reader of the show, I appreciate what you've been doing to spread great information out there.

Thanks. It's great to have you on. Thanks for sharing as well and all that you're doing.

Important Links

• David O’Hara on LinkedIn
• David@BraceHealth.com
• High-Performance Practice Conference
• Brace Health
• Maximize Clinic Profit & Drop Low-Paying Insurances – Previous Episode
• BraceHealth.com/Nathan
• Drop Your Lowest Paying Insurances With Trace Kennemore, DPT – Previous Episode
• How to Win Friends and Influence People

David David O'Hara