Payers

In healthcare, the term “payer” refers to an entity responsible for financing and/or reimbursing the cost of health services. These entities can be private insurance companies, government entities/programs, employer plan sponsors, or other organizations that manage healthcare expenses. While they typically are not responsible for care delivery, payers have a vital role in shaping how, when, and where patients access medical services—through the policies, coverage rules, and payment models they define. This chapter discusses the different types of payers and the tools they use to influence how care is delivered.