Reader Question: Our largest payer hasn’t given us a rate increase in five years, but our costs continue to climb. We’re sure this isn’t sustainable if the trend continues, so we need to look at lowering our costs. How do we start with this process? When thinking about the sustainability of your organization and the business models of your programs, you need to consider both revenue and cost. And though your largest payer has not given your organization any recent rate increases, I wouldn’t dismiss the revenue side of your business outright . . .