Round 2 Sample Negotiation

"Same Rate, Bigger Deal"

What's Missing in Round 1

In this Round 1 script, notice what never gets mentioned, even though clues exist in the role briefs:

No discussion of joint employer strategy (e.g., ABC Manufacturing asking for NorthRiver).

No mention of co-funded care management or data infrastructure.

No exploration of phased VBC pilots, admin simplification, or JOC governance.

Both sides feel the clock, feel the PR and board pressure, and collapse the negotiation to a single dimension: the rate number. They do technically "win" by avoiding disruption, but they walk away having optimized only the urgent, not the total value or the relationship.

Ground Rule Reminder

Rate and escalator from Round 1 (285% + 3% escalator) are off-limits.

Objective now: create more value and a better relationship without changing that number.

Reframing the Conversation (Minutes 0–3)

Provider (NorthRiver):

"Okay, so Round 1, we did what we needed to do: we avoided disruption and landed at 285% with a 3% escalator. That solved the immediate crisis. For this round, I'd like to assume the rate is locked and ask a different question:

If the rate is fixed, what would make this a great deal for both of us over the next 3–5 years, not just an acceptable one for the next 3–5 days?"

(This is a deliberate "tension token" — naming that Round 1 was crisis-mode and inviting a deeper conversation.)

Payer (HorizonHealth):

"I agree. We both sprinted to avoid the cliff. If we're not touching 285%, then I'd be interested in what we can do around stability, predictability, and maybe some ways to bend trend together instead of just arguing about it next cycle."

Surfacing Interests and Clues (Minutes 3–6)

Provider:

"From our side, two big things:

  • We need more revenue stability and less whiplash from annual fights.
  • We want to move our investments in readmissions and ED care from 'nice-to-have' to something we're rewarded for, not punished for."

Payer:

"On our side:

  • We need better cost trend performance, especially for avoidable ED and readmissions.
  • We're under a microscope with employers and the public. We need visible proof we're solving problems with our key health systems, not fighting them."

Provider (leaning into tension):

"It's ironic — we both invested in areas that would help each other, but in Round 1 we were too busy wrestling over the rate to touch any of it."

(Short silence — letting that land.)

Payer:

"Fair. We defaulted to the rate fight. Let's fix that now."

Opportunity 1: Joint Employer Strategy (Minutes 6–8)

Provider:

"There's one specific opportunity we ignored. Our analytics team flagged ABC Manufacturing, about 8,000 lives, asking specifically about us in your renewal cycle. In Round 1, that felt like a distraction from the rate.

What if we treated that as a joint asset instead: we go to ABC together with a unified story — quality, access, and a shared commitment to cost management?"

Payer:

"That's interesting. Retaining an 8,000-life group like that is worth a lot more to us than a few points on the rate.

What would you want in return for a joint employer strategy?"

Provider:

"Two things:

  • A clear commitment that we're your anchor system in this market for those employers.
  • A joint plan and cadence — maybe we co-sponsor 2–3 employer forums a year and co-own a dashboard around quality and access metrics."

Payer:

"I can work with that. We benefit from reduced churn and better story for our sales team. Let's write in a joint employer engagement plan as part of this agreement:

  • Identify 3–5 priority employer groups annually.
  • Co-develop employer-facing quality and access materials.
  • Commit to at least two joint pitches or renewal meetings per year."

Opportunity 2: Shared Data & Care Management Pilot (Minutes 8–12)

Payer (using their tension token):

"There's something on our side we didn't put on the table either. Our care management team has capacity to do a focused pilot on high ED utilizers, but we haven't had the right data-sharing partnership to make it work.

What if we co-design a readmissions/ED pilot, starting upside-only for you, tied to real-time data feeds?"

Provider:

"That's exactly where we've already put money — care pathways and post-discharge follow-up. In Round 1, we had no room to bring that up; it felt like 'extra.'

If the base rate is locked, here's what would make a pilot meaningful to us:

  • Year 1: upside-only shared savings on avoidable readmissions and ED visits.
  • Clear benchmark methodology we can see and validate.
  • Commitment to shared infrastructure — we don't want to build redundant analytics if you already have some of it."

Payer:

"Reasonable. How about:

  • We identify a defined cohort (for example, CHF/COPD, top ED utilizers).
  • We fund 50% of the incremental analytics and data integration costs.
  • We share 50/50 in any savings above baseline in Year 1, with no downside to you.
  • If it works, in Year 2 we can talk about a modest downside corridor, but we don't bake that into this first amendment."

Provider:

"That structure would let us actually monetize the work we've already started, without taking on risk we're not ready for. Let's capture that as a phased VBC pilot attachment."

Opportunity 3: Administrative Simplification & JOC (Minutes 12–15)

Provider:

"One more area: a lot of our effective rate erosion is operational — denials, PAs, slow issue resolution. If we're serious about making 285% real, we should fix some of that together."

Payer:

"Agreed. Our teams spend a ton of time fighting over the same problems. What are your top two pain points?"

Provider:

"First, prior auth for services where our performance is already strong. Second, the lack of a structured venue to fix recurring issues before they become crises."

Payer:

"Alright. On PA:

  • We can implement a gold-card approach for selected services where your denial and overturn rates are consistently low.
  • We reduce PA touchpoints there and re-focus on areas with genuine overuse risk."

Provider:

"That would meaningfully reduce friction and cost. On governance, I'd like to see a Joint Operating Committee written into the contract — not just informal calls when things blow up."

Payer:

"Let's define it:

  • Monthly JOC for the first year, then at least quarterly.
  • Standard agenda: claims performance, denials, PA metrics, pilot performance, and employer feedback.
  • Ability for either side to escalate unresolved issues from JOC to senior leadership within a defined timeline."

Provider:

"That kind of structure makes this feel like a living relationship, not just a rate sheet."

Closing Round 2: Naming the Shift

Payer:

"So if we summarize Round 2 — with the rate unchanged at 285% — we've added:

  • A joint employer engagement strategy, starting with ABC Manufacturing.
  • A co-funded, upside-only VBC pilot on readmissions/ED utilizers.
  • Admin simplification through gold-card PA on selected services.
  • A formal JOC with clear escalation paths."

Provider:

"Exactly. In Round 1, we traded only in price. In Round 2, we traded in creativity, trust, and long-term value — without moving a single point of rate.

If we actually negotiated like this in the real world, we'd fight less every cycle and build something that compounds over time."

Payer:

"And candidly, showing up this way under pressure is what makes me want to keep building with you, not just tolerate you as a must-have network partner."

This Script Shows Participants:

  • •How to pivot from a single-issue rate fight to a multi-issue value-creation conversation.
  • •Where the subtle clues from the "Information Only You Know" sections get activated (ABC Manufacturing, care management capacity, data needs).
  • •Why embracing tension changes not just the economics, but the tone of the relationship going forward.