Negotiation techniques


Managed care contracts have decreased the need for price negotiations between case managers and a provider as pricing is set in advance. But there are situations where negotiating cost is still needed, such as when working with out of network providers or if the service is not covered by the managed care contract. Case Managers negotiate things other than cost; such as length of stay, approval of needed services, and extra contractual benefits. 

So What is Negotiation and How Can Case Managers Use it Effectively?

Negotiation is the reaching of an agreement through discussion and compromise. The aim of negotiation is to explore the situation, and find a mutually acceptable solution. 

Two Types of Negotiation

Aggressive or Hardball
This type seeks a winner and a loser. It uses manipulation, intimidation, ridicule and tricks. Aggressive negotiation results in undermining trust and damaging future relationships. It is not recommended for Case Managers, as it can easily result in deadlock, leaving the patient without the needed service. It also burns bridges for future negotiations.

Seeks a win-win, and results in the best outcome for everyone. The negotiator is trustworthy, objective and fair. This approach results in agreements faster than the aggressive technique and facilitates future negotiations. 

The Negotiation Process

Key to the negotiation process is developing a relationship with the other party. You both have a common interest, the patient, and ensuring he gets the required service. Build upon this with respect for the other party. This can be as simple as returning voice-mail or email promptly. Eventually this will build into trust, which will enhance the negotiation process.

Equally important in the negotiation process is communication. This includes not only what you say, but how you say it, and how well you listen. In face to face communication this also includes body language. Make sure what you say is clear and concise. Engage in active listening by paying attention to what is being said, and not preparing what you are going to say next. Summarize their comments and ask questions to clarify and ensure you understand their point.

Negotiation starts with preparation, carry out research to understand the other person’s side. (If negotiating price, know the price of competitors.) Next, establish the problems and the goals with the other party. Failure to agree upon goals can make the negotiation process difficult. Once the goals are established, determine what areas you agree on, these can be put aside, and what areas you disagree on. On the areas where there is disagreement, begin to work toward compromise. The negotiation is deemed successful when a mutually agreeable resolution is obtained.

Effective negotiation is an important tool the case manager can use with patients, caregivers and physicians as well as payers and vendors. Once relationships are built, subsequent negotiations will be smoother and more enjoyable. 

Key Points

Case Managers use Negotiation To:

  • Work with patients and care providers to develop a realistic plan of care
  • Obtain approval for needed services
  • Control cost
  • Obtain benefits outside of the benefit contract
  • Determine length of stay