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Payer Mix
The payer mix refers to the proportion of patients under government medical plans such as Medicaid and Medicare compared to private or commercial insurance plans. It gives a representation of financial reimbursement plans which in turn determines the quality of health care. More straightforwardly, the payer mix can be interpreted to mean the percentage of patients enrolled in private health insurance. To understand the role of the payer mix in health care marketing, it is essential to contextualize the idea of payers. In the context of the health care providers, the payer negotiates the rates for offering health services, revenue collection, and payment of claims (Allen, 2012). Thus, with those financing controls in place, the aspect of marketing...
For example, when government policies affect the financial positions of hospitals through penalization, those hospitals are impaired, leading to low performance and ultimately leading to a lower payer mix.
Understanding of the payer mix relates closely with insurance. Often, insurance reimburses funds at a lower rate than the health providers. Here, we find that the figures recorded by the insurer can give a false representation of the actual financial costs. This form of analysis enables hospitals and the overall health care sector to formulate marketing strategies that seal the significant risk introduced by the financial disparities (Manary, Staelin, Boulding, & Glickman, 2015). Misunderstanding of the payer mix can lead to bad debt, especially when hospitals make considerable investments in marketing. In the same context, publicly funded health institutions receive lower private insurance funds than private ones and serve more patients (hfma, 2020; Allen, 2012). The implication is that the payer mix provides a signal of the net revenue. In this context, we can view the payer mix as the difference in payment between…
References
Allen, R. L. (2012). PRACTITIONER application: Payer mix and EHR adoption in hospitals. Journal of Healthcare Management, 57(6), 449-450. doi:10.1097/00115514-201211000-00012
Hfma. (2020). Hospitals predict significant shifts in payer mix, revenue cycle operations post-pandemic. Retrieved June 09, 2021, from https://www.hfma.org/topics/hfm/2020/november/hospitals-predict-significant-shifts-in-payer-mix-revenue-cycle-operations-post-pandemic.html
Manary, M., Staelin, R., Boulding, W., & Glickman, S. W. (2015). Payer mix & financial health drive hospital quality: Implications for value-based reimbursement policies. Behavioral Science & Policy, 1(1), 77-84. doi:10.1353/bsp.2015.0007
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