Podcast Summary: "The Next Chapter of IDR: Trends, Metrics, and Strategies for Providers"

Becker’s Healthcare Podcast
Host: Chris Sosa
Guest: Patrick Vellachi, Chief External Affairs Officer, Halo md
Date: December 4, 2025

Overview

This episode of Becker’s Healthcare Podcast explores the evolving landscape of Independent Dispute Resolution (IDR) under the No Surprises Act (NSA). Chris Sosa interviews Patrick Vellachi, drawing on his wide-ranging experience across provider, payer, and policy sectors. They discuss emerging trends from early IDR cases, important metrics for budgeting, and how leaders can use recent data to inform their revenue and negotiation strategies.

Key Discussion Points & Insights

1. Background & Patrick Vellachi’s Experience

• Patrick shares a multi-faceted healthcare policy background, having worked on Capitol Hill, for payers (Humana and Anthem/Elevance), the Federation of American Hospitals, Envision Healthcare, and now Halo md.
  • “I like to say I think the only sides of the table I haven't sat on are probably pharma and med device.” (01:08 - B)

2. Emerging IDR Trends & What They Mean for Providers

• Publicly available CMS data shows providers consistently winning around 80% or more of IDR arbitrations.
• The strong provider win rate encourages providers to consider IDR for out-of-network disputes.
  • Quote: “They've shown consistently about an 80% or higher success rate on the provider side of the equation...when providers engage in the arbitration process, they usually win and are able to obtain fair and sustainable rates." (01:35 - B)
• Patrick emphasizes that the IDR process is a valid solution for concerns about out-of-network reimbursement.

3. Key Metrics and Challenges for Budget Planning

• Expect increased uncompensated care due to laws like the OPBA and possible loss of exchange subsidies.
• Unfavorable payer mix and reductions in Medicare physician fee schedule could further erode reimbursement.
  • Quote: “You're likely to see increased rates of uncompensated care and unfavorable payer mix...facilities really need to understand those different risks and start to identify opportunities to fill those holes.” (03:15 - B)
• Many service lines are subsidized by hospitals; hospitals need to be prepared for physicians to request increased subsidies.

Strategic Takeaway:
Facilities that proactively assess and plan for these shifts—using tools like IDR to close revenue gaps—will fare better than those who wait.

4. Negotiation Strategies with Payers – Using IDR Leverage

• NSA and IDR were designed to drive sustainable, in-network contracts.
  • The arbitration process creates an "economic equilibrium" by revealing fair rates both sides can reference.
• Despite positive trends, most organizations have been slow to shift toward permanently sustainable network arrangements.
  • Quote: “It's a little discouraging that we haven't seen that really take place yet. I think the adjustment period is taking a little longer than most of us anticipate.” (05:43 - B)
  • “The IDR process is not the last resort when negotiations fall apart. It's a tool in the toolbox toward finding that sustainable equilibrium...to drive toward a durable in network arrangement.” (06:40 - B)

5. Current Climate & Utilization of IDR

• The strong provider win rate (~80%) demonstrates to payers that prevailing rates are fair and sustainable, incentivizing both sides to settle in-network.
  • Quote: “If we want to address some of those costs, the answer is get in network at the rates that have been prevailing in the IDR process.” (07:37 - B)
• The cumbersome nature of arbitration is deliberate: “The arbitration process was designed to be cumbersome and expensive so that folks didn't rely on it on either side...” (07:10 - B)
• Patrick expresses hope that these trends will push markets to a “tipping point,” driving more sustainable in-network deals.

6. Underutilization and Opportunity—Especially for Facilities

• Misconception: Some facilities think IDR is only for ED visits or limited situations.

  • Patrick urges hospitals and systems to reevaluate their eligibility, as there is “a whole lot more opportunity than...realize.” (08:28 - B)

• Noteworthy moment: Major health systems are seeing growth thanks to improved IDR outcomes, as cited on a recent HCA earnings call.

  • Quote: “Folks who have maybe written that off and thought, hey, this is really mostly for providers, facilities really ought to take a look and see whether there's an opportunity to stabilize revenue through some of those IDR opportunities.” (09:07 - B)

Notable Quotes & Memorable Moments

• “They've shown consistently about an 80% or higher success rate on the provider side of the equation...the message is...the IDR process might be a solution worth considering.” (01:35 - B)
• “Facilities really need to understand those different risks and start to identify opportunities to fill those holes or solutions for efficiency and improve improvement of their operations. And the facilities that do that now are going to be a whole lot better shape than the ones that do it six months from now...” (03:47 - B)
• “The IDR process is not the last resort when negotiations fall apart. It's a tool in the toolbox toward finding that sustainable equilibrium...” (06:40 - B)
• “There are unnecessary costs in the system from arbitration fees and from the cost of the process. That's intentional...the answer is get in network at the rates that have been prevailing in the IDR process.” (07:10 / 07:37 - B)
• “For folks who have maybe written that off and thought, hey, this is really mostly for providers, facilities really ought to take a look and see whether there's an opportunity to stabilize revenue through some of those IDR opportunities.” (09:07 - B)

Timestamps for Important Segments

• 00:25 – 01:21 Background and experience of Patrick Vellachi
• 01:35 – 02:16 Provider win rates in IDR outcomes and implications
• 02:28 – 04:55 Financial and operational challenges for facilities and key metrics to watch
• 05:06 – 06:48 Negotiation strategies and the intent behind NSA/IDR
• 06:56 – 08:20 Trends, tipping point, and market dynamics in IDR
• 08:25 – 09:20 Underutilized IDR opportunities for hospitals and facilities

Conclusion

This episode provides actionable insights and a hopeful outlook on IDR as both a negotiation tool and a revenue stabilizer under the No Surprises Act. The strong record of provider success in arbitration suggests opportunities for both providers and facilities to improve financial performance and drive more sustainable, in-network relationships with payers. Facilities are encouraged to reassess their use of IDR, stay alert to emerging financial pressures, and use this moment to strategically recalibrate.