As value-based care gains momentum in gastroenterology, ASCs must prove their worth to payers — demonstrating cost savings, efficiency and superior patient outcomes.
Geogy Vennikandam, MD, COO of Chicago-based GI Partners of Illinois, is at the forefront of this effort, championing data-driven strategies to secure payer buy-in for ASCs.
Dr. Vennikandam joined Becker's to discuss the key strategies his team is using to align with payers.
Question: What strategies have been most effective in terms of gaining payer buy-in for these models in the GI space?
Dr. Vennikandam: One of our main strategies is demonstrating value — cost savings and improved patient outcomes. When I’m on calls with payers, my goal is to show cost savings and efficiency. Everything is data-driven, so I provide case studies proving that shifting procedures to ASCs results in a lower total spend for payers.
I also highlight the cost-effectiveness of ASCs compared to hospitals by showing reduced facility fees and procedural costs. Additionally, I showcase our low complication rates, quicker recovery times and high patient satisfaction.
We’ve implemented QR code-enabled ID cards at our nine locations. When a patient wants to provide feedback, they can scan the QR code, which redirects them to our review site. This allows us to gather real-time patient feedback and present that data to payers.
Another effective strategy is proposing bundled payment models for specific procedures, allowing payers to predict costs and share in savings. With Blue Cross Blue Shield, for example, we’re exploring risk-sharing agreements where ASCs assume some financial responsibility for outcomes, which gets their attention. Transparent pricing models are also essential. I traveled to Dubai to study their healthcare model, and one thing I noticed is their emphasis on transparency — something we’re working to improve here.
Q: And what are the biggest obstacles in securing payer contracts?
GV: Reimbursement rate challenges are a big one. ASCs are reimbursed at lower rates compared to hospitals, making sustainable contracts harder to negotiate. There are also site-of-service differentials, where payers may favor hospital outpatient departments over ASCs due to existing contracts.
Prior authorization is another major barrier — it’s a lengthy process that delays care and adds administrative burdens. Plus, there are inconsistencies in criteria across payers, requiring us to file appeals and additional documentation.
Limited procedure coverage is another issue. Some payers are slow to approve higher-acuity cases for ASCs despite clinical evidence supporting their safety and efficiency. Additionally, Medicare and commercial insurers sometimes restrict procedures, which limits volume potential. Market consolidation also gives major payers more negotiating power over ASCs, making it challenging to secure favorable contracts.