As payer expectations evolve and reimbursement pressures mount, gastroenterology leaders are rethinking how they engage with insurers.
From value-based care to contract renegotiations and patient education, four GI leaders shared with Becker’s how they’re adapting to a shifting payer landscape — and what they’re preparing for next.
Editor’s note: Responses were edited lightly for clarity and length.
Question: What’s been the biggest shift in your payer relationships/strategy in the last year — and how are you preparing for what’s coming next?
Omar Khokar, MD. Gastroenterologist of Illinois GastroHealth (Bloomington): This is ongoing, but the biggest change is collaborating with payers to demonstrate the value of care in the ASC setting. In terms of next steps, we need AI integration into “smart screening” strategies, and ultimately ASCs need to choose tighter payer alignment — choosing partners whose goals align with our clinical mission. That means saying no to low-performing contracts and yes to deeper partnerships with high-performing payers that reward value.
Geogy Vennikandam. Chief Operating Officer of GI Partners of Illinois (Chicago): Over the past year, the biggest shift in our payer relationships has been a strategic pivot toward value-based care and proactive engagement with payers to align on outcomes that matter most to patients and employers alike. We’ve seen increased pressure on fee-for-service reimbursement and narrower networks, which has required us to be more data-driven and collaborative in how we demonstrate our clinical quality, efficiency, and cost containment.
In response, we’ve invested in infrastructure to improve care coordination, leverage data analytics for performance tracking, and standardize protocols across our growing network. We’re also building stronger direct lines of communication with payers, both locally and regionally, to jointly explore innovative reimbursement models, including episodic payments and shared savings arrangements.
Looking ahead, we’re preparing for continued consolidation and payer vertical integration by strengthening our scale and negotiating position — not just through size, but through demonstrable quality, operational consistency, and patient satisfaction. Our aim is to be a high-performing GI partner of choice for value-based contracts while remaining nimble and aligned with the evolving expectations of payers and employers alike.
Helen Lowenwirth. Administrator at East Side Endoscopy (New York City): We are increasingly devoting more resources to provide patients with explanations of anticipated reimbursement and patient responsibility prior to dates of service while encouraging them to reach out to the payers in advance to confirm coverage limits.
Pradnya Mitroo, MD. President of Fresno (Calif.) Digestive Health: The biggest shift in our strategy with payers has been trying to renegotiate some of the contracts we have especially with our biggest commercial payors. Recently we were able to negotiate to have some of the plans start paying for the second procedure done at the same time (i.e. paying half-charge for the EGD performed at the same time as the colonoscopy). For the future, data-driven negotiation will be very important. We plan on using cost and outcome data to show insurers that we can deliver care more cost effectively than hospitals and with better quality and higher patient satisfaction.
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