PAYER CONTRACT NEGOTIATIONS

Contract review, payer due diligence and negotiation assistance

SITUATION ASSESSMENTS

Are you prepared to negotiate and participate?

Why you? Why now? 

Managed care provider networks rarely negotiate with small to medium size practices, that's why you need to know exactly what you are signing up for to pledge that you'll follow the rules and meet their standards. 

But that just gets you a foot in the door. Will the treat you like a commodity or a premium brand?

We examine and summarize your brand value and appeal to the payer networks you want to join. We've analyzed and negotiated contracts from most major and intermediary HMOs and PPOs, as well as contracts directly with self-insured employers and labor unions. This includes narrow networks, carve out deals, and contracts for integrated health delivery systems, ACOs, IPAs, PHOs, and MSOs.

What's your situation?

Our clients started out by calling us because they typically fall into following 5 categories. They: 

  • have no established brand value or brand equity. They just want a chance to see some patients as an in-network provider
  • are already in networks, and want to remain in, but haven't had seen an increase in their reimbursement in years
  • are already in networks through a group practice but they want to go off on their own or relocate and need to extricate from the group and start fresh with a new contract
  • are at the point where they are debating to remain in network or pursue an out of network strategy with certain payers
  • have decided to change their business model to concierge medicine and have heard rumors that they'll be kicked out of the network if they do
CONTRACTING STRATEGY

Which contracts do you want and why?

Do you know what to look for? Have you determined your prioritized ground rules for accepting or rejecting contracts in your specific situation?

Managed care provider networks send you their boilerplate agreements  via email. Rarely do they come visit you face to face like they did in the old days. 

Are you ready to accept the offer and sign on the dotted line? Just because they haven't come to your location, doesn't mean you cannot negotiate changes as necessary.

Let's prioritize what's important to you, what isn't important and prioritize those nice to have's and dealbreaker "gotta haves".

From there, we'll examine the contract, suggest practical revisions and round out your entrance strategy with declination metrics that tell you when its time to be concerned or prepare to give notice of cancellation or termination.

Much of the contracting strategy we develop with clients is done without travel cost. We meet by phone or video conference, you supply us some requested data from your revenue management files, we meet with key decision makers and we write up the model strategy for you based on what we analyze and interpret.  This gives your contracting team the road map it needs to do its best work. If they need a little coaching along the way, we're just a phone call away.

SHARED RISK

Do you know how to share risk for value based care and not get burned?

Much of what we teach our clients about shared risk is risk mitigation tactics in contracting. We do this by first finding the hidden risks they never considered before.  Then we review the contract to see what the payer glossed over or failed to address. 

Managed care provider networks send you their boilerplate shared risk agreements, but it is rare that contracts are custom tailored to a specific geographic area or its population.

 

Read this informative article from Maria Todd about risk contracting and value-based care to learn about how we help you plan and execute a shared risk strategy for healthcare services and deal with all of its touch points and potential perils and pitfalls.

Whether the offer is capitation or bonus payments under pay for performance, we help you prepare for risk pool audits and settlements, financial modeling and alternative contracting arrangements. We show you how to use your CHNA and existing technology and software, coupled with data from CPT and ICD-10, to make a 360° panorama view of the risk you plan to undertake.

The age old adage is that you control that which you can and insure the rest.  Before we let you fly on your own, we address the last and final detail: excess loss insurance ("reinsurance") to mitigate runaway losses that could otherwise bankrupt you. We don't sell reinsurance and we're not tied in any way to any seller. We are your advocate in the negotiation. Count on us to treat your risk as if it was our own!

Master Classes with Maria Todd

Maria Todd offers Master Classes for healthcare executives, physicians and managers throughout the year on a variety of topics. Master Class registration is limited to 12 participants to allow for more personalized interaction during the course.  Classes will run with a minimum of 4 participants.

Upcoming Master Classes

Growth Hacking for Medical Tourism®
1 DAY - DENVER, COLORADO
Fri, Jul 14, 9:00 am

The Art of Payer Contract Analysis®
Mon, Jul 17, 9:00 am - DENVER, COLORADO
2 DAYS

Analyzing & Negotiating Shared Risk Agreements®
1 DAY - DENVER, COLORADO
Mon, Aug 14, 9:00 am

The Art of Payer Contract Analysis®
2 DAYS - ST-GEORGE, UTAH
Mon, October 16, 9:00am

Analyzing & Negotiating Shared Risk Agreements®
1 DAY - ST-GEORGE, UTAH
Mon, Nov 06, 9:00 am

If you plan to register 3 or more Master Class participants at any single program, contact us first. You may be better served scheduling a private course at your location.

Registration: 800.727.4160

Optimizing every area of revenue management!

From contract analysis to root cause analysis to drafting the appeal, to submitting for external review, we cover it all.

GET IN TOUCH...

To arrange a consultation or workshop for your team or association, please send us a message.