PAYER CONTRACTING SERVICES

Negotiations with health plans can be challenging under the best of circumstances.

Existing contract assessment, reimbursement analysis, and facilitation of the negotiation all take time and an ability to analyze information and model scenarios on a real-time basis. Plus, new value-based payment methodologies present very different scenarios for providers to consider.

In addition to the time it takes to embark on such an endeavor, it can become overwhelming to identify and organize the information necessary for negotiations and to deploy consistently a contracting strategy.

healthcare payer contracting

We can help you identify where you want to be on the managed care contracting continuum and provide the necessary support to get you where you’re going.

Here’s how we can help:

Payer Contracting – Work Streams

Successfully shifting from fee-for-service to value-based methodologies requires getting your house in order:

  • Understand current contract performance.
  • Appreciate market conditions:
      • Payers
      • Employers
      • Referral base
      • Patients
      • Networks
  • Alternative payment models.
  • Articulate mission and goals.
  • Outline practice attributes – services, geography etc.
  • Define critical questions getting to the heart of the matter.
  • Identify negotiation team including business and clinical perspectives.
  • Plan approach including timing and deal breakers.
  • Determine your value proposition clearly, concisely and quantifiably.

We work with providers to identify where you want to be on the payer contracting continuum and provide the support to get you where you’re going.

F e e f o r S e r v i c e P e r f o r m a n c e B a s e d B u n d l e P a y m e n t s S h a r e d S a v i n g s S h a r e d R i s k G l o b a l P a y m e n t s L e v e l o f E c o n o m i c R i s k D e g r e e o f P r o v i d e r I n t e g r a t i o n Payer Contracting Continuum
F e e f o r S e r v i c e P e r f o r m a n c e B a s e d B u n d l e P a y m e n t s S h a r e d S a v i n g s S h a r e d R i s k G l o b a l P a y m e n t s L e v e l o f E c o n o m i c R i s k D e g r e e o f P r o v i d e r I n t e g r a t i o n Payer Contracting Continuum

Payer Contracting – Strategy

A key work stream in our process involves a deep dive around how your payer partners, patients and referral sources view your practice:

Payer Payer 1 Payer 2 Payer 3 Transparency Site A Transparency Site B
Provider A Tier 1 Meets Quality, Not Cost Not Listed Cost > Peers Not Listed
Provider B Tier 2 Premium Designated CIGNA Care Designated Not Listed ** Stars
Provider C Not Listed Not Listed CIGNA Care Designated Cost < Peers * Star
Provider D Tier 2 Not Enough Data – Cost Not Listed Cost > Peers Not Listed
Provider E Tier 2 Meest Quality, Not Cost CIGNA Care Designated Not Enough Data **** Stars
Payer Payer 1 Payer 2 Payer 3 Transparency Site A Transparency Site B
Provider A Tier 1 Meets Quality, Not Cost Not Listed Cost > Peers Not Listed
Provider B Tier 2 Premium Designated CIGNA Care Designated Not Listed ** Stars
Provider C Not Listed Not Listed CIGNA Care Designated Cost < Peers * Star
Provider D Tier 2 Not Enough Data – Cost Not Listed Cost > Peers Not Listed
Provider E Tier 2 Meest Quality, Not Cost CIGNA Care Designated Not Enough Data **** Stars

We begin with fully assessing your situation in terms of current arrangements and propose a strategy based on your short and long term goals:

Contact us to leverage our Payer Contracting Services.