How Can Nonprofits Keep Their Power as Health Plans Consolidate Control?
- HiQuity Solutions
- Sep 29
- 3 min read
Updated: Oct 15
4 of 8 - Thriving Through Policy Whiplash: A Nonprofit Guide for Behavioral Health
Across the country, behavioral health leaders are encountering a new reality: negotiating
with health plans that are larger, more powerful, and less constrained than ever before. The
ten largest insurers now cover more than half of all Americans with insurance (AMA). In
many states, one or two carriers dominate entire markets. For nonprofits, this means fewer
options, reduced leverage, and increased pressure to accept contracts with downside
financial risk.
At the same time, Medicare Advantage enrollment continues to climb, covering more than
54% of eligible beneficiaries in 2025 (KFF). These plans are not only growing but also
innovating in behavioral health, launching digital-first networks and integrating behavioral
health into primary care. For providers, this shift can open doors to new populations, but it
also consolidates power in the payer's hands.
Why Consolidation Matters for Behavioral Health Nonprofits
Consolidation is more than a market statistic. It changes the terms of survival
for nonprofits:
Less leverage in rate negotiations: When there are only one or two viable payers in a
region, providers often must accept contract terms that erode sustainability.
More complex contract structures: Risk-based arrangements require infrastructure,
data systems, and actuarial expertise that many nonprofits lack in-house.
Shifting definitions of value: Payers are increasingly dictating which outcomes
matter and how they will be measured, forcing nonprofits to align their operations
with external priorities.
Left unaddressed, these dynamics can strip nonprofits of their independence and mission
focus.
The HiQuity Approach: Regaining Strategic Power
At HiQuity, we help nonprofits approach consolidation not with resignation, but with
strategy. Even in highly concentrated markets, community-based providers can reclaim
leverage by adopting a disciplined approach.
Data-Driven Negotiation: Payers value outcomes and cost savings, and nonprofits must
bring that data to the table. Demonstrating reduced hospitalizations, improved medication
adherence, or crisis diversion outcomes lends credibility to providers. In a market where
insurers are under pressure to prove value, data becomes a bargaining chip.
"Healthcare negotiations are shifting from informal exchanges to structured, evidence-based discussions. Access to clear, well-organized operational and financial data equips providers with the ability to demonstrate their performance in key areas, such as claim efficiency, documentation quality, and patient service delivery. By presenting such information, providers can move beyond general appeals and make a compelling case for fairer reimbursement rates, shorter payment cycles, and more flexible contract terms. Data introduces objectivity into the conversation and establishes a foundation of mutual understanding between both parties." (Dr. Muhammad Abdul-Hameed)
Coalition Building: Nonprofits often negotiate alone, weakening their position. By
forming coalitions with peer organizations, providers can negotiate collectively, share
infrastructure, and achieve economies of scale. Coalitions also provide a unified voice in
policy advocacy, counterbalancing the influence of large insurers.
Selective Contracting: Not every contract is worth accepting. Providers must assess
whether terms support sustainability, mission alignment, and quality outcomes. Walking
away from unsustainable agreements can be difficult, but it is sometimes essential to
preserve organizational integrity.
Beyond Contracts: Reframing the Payer-Provider Relationship
Ultimately, the path forward requires nonprofits to see payers not just as adversaries but as
potential partners. Insurers are grappling with high medical loss ratios and rising consumer
acuity. They need behavioral health providers who can deliver quality care efficiently. The
organizations that thrive will be those that position themselves as indispensable allies, not
passive contractors.
At HiQuity, we support nonprofits in developing the data, strategy, and executive bandwidth
to renegotiate relationships with payers on stronger terms. By aligning mission-driven care
with payer incentives, nonprofits can retain influence even in consolidated markets.
👉 📂 Download the HiQuity Risk-Based Contract Checklist to evaluate payer proposals and
identify which agreements build sustainability, and which may put your organization at
risk.
Are you having these conversations with your consulting teams? If not, let us know.
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