For infusion centers, a strong portfolio of health plan contracts isn’t optional—it’s the foundation of patient access, referral relationships, and sustainable growth. Being in-network with the right health plans allows you to reach more patients, strengthen referral relationships, and stabilize reimbursement.
Drawing on more than 20 years in managed care and market access, I’ll share proven strategies infusion centers can use to improve their contracting success.
Prioritize the Right Health Plan Targets
Data is king. Enrollment data helps you identify where your contracting efforts will have the greatest impact. While it requires an upfront investment, the ROI is clear: you’ll know exactly which health plans offer the largest patient opportunities.
Rank your targets. Create a priority list of health plans in your market, ranked by covered lives. This gives you clear direction and a measurable goal—for example, “secure access to 70% of covered lives.”
Don’t overlook national networks. Contracting with national PPO networks can expand patient volume and provide consistent reimbursement. While rates are discounted, they are predictable, giving you stability as you grow.
Define and Communicate Your Value Proposition
Solve a need. Health plans want to know how you make their network stronger. Beyond lowering costs, are you improving patient access? Reducing hospitalizations? Enhancing the prescriber experience? Back up your claims with data whenever possible.
Go beyond the paperwork. When submitting credentialing documents, include brochures or sell sheets that highlight your value proposition. This small step helps decision-makers see the unique value you bring to their network.
Build Relationships That Open Doors
Expect obstacles. Network managers may say their panel is full, or they may offer rates below your threshold. That’s when persistence and relationships become critical.
Find an internal champion. Use LinkedIn and your professional network to identify key leaders—such as a VP of Network Management or a Chief Medical Officer—who may advocate for you. A warm introduction through a mutual contact greatly improves your chances.
Do your homework. Research your potential champion before reaching out. Look for shared interests or priorities that can help build rapport.
Be creative. During discussions, listen for ways to add value. Could you partner with an existing network provider? Explore a performance-based contract? Propose a pilot program to prove your value? Creative solutions often turn a “no” into a “let’s talk.”
Final Thoughts
There’s no single shortcut to managed care contracting success. But by targeting the right payers, clearly defining your value, and cultivating strong relationships, infusion centers can dramatically improve their ability to secure contracts and serve more patients.
About the Author
Tom Roark, Vice President of Payer Strategy and Contracting at Local Infusion, has more than 30 years of experience in healthcare management. His expertise spans payer contracting, reimbursement, business development, and market access strategy. Learn more at www.mylocalinfusion.com.
