Financial Operations and Transactions

Payer Contracting Strategies

A number of trends are driving payers to employ various strategies such as ACOs, bundled payments, narrow networks or reference pricing, and private label plans as well as acquiring provider organizations and entering the retail health business. Now is the time to reexamine your payer contracting strategies to determine how best to create value-based networks with health plans. However, when it comes to payer negotiations, you cannot follow the same tried-and-true playbook – it just will not work in this new environment. You must be flexible, take into account payer speed of adoption of value-based reimbursement, and understand your readiness for clinical integration and a variety of payment methods and market segmentation strategies.

We have worked with hospitals and physician organizations for more than 25 years in developing and implementing customized managed care strategies. We are advisors to many IPAs, medical groups, and ACOs throughout the country and facilitate hospital-physician group relationships relative to managed care strategy. Now more than ever the linkage between financial and market strategies is key to determining how to maintain/grow the health system’s commercial as well as appropriately respond to government-based risk business (Medicare Advantage and Medicaid managed care). Our experts have the experience to guide you and prepare accompanying financial models and risk assessment tools as you prepare to adopt risk- and value-based arrangements with payers.