Optimizing payer contracts with managed care benchmarking and strategic insights
Learn how managed care benchmarking, price transparency and strategic payer contract negotiation helped a healthcare provider secure $22M in opportunities and achieve a greater ROI.
Client background
A high-performing healthcare provider system in Western Pennsylvania sought to optimize its managed care contracts. The organization operates multiple facilities and is committed to delivering high-quality patient care. To ensure financial sustainability and strengthen its negotiating position, they aimed to use managed care benchmarking alongside normative regional market data and price transparency information to benchmark their payer contracts.
The business challenge
The organization needed to renegotiate contracts with four leading payers across ten product lines but lacked visibility into how their contracted rates compared to regional benchmarks and competitors. Key challenges included understanding their position in the market and identifying financial opportunities based on payer-negotiated rates. Additionally, the organization required a review of facility contract terms and language, as well as local geographical benchmarking data to guide their negotiations.
Strategy and solution
The organization needed to renegotiate contracts with four leading payers across ten product lines but lacked visibility into how their contracted rates compared to regional benchmarks and competitors. Key challenges included understanding their position in the market and identifying financial opportunities based on payer-negotiated rates. Additionally, the organization required a review of facility contract terms and language, as well as local geographical benchmarking data to guide their negotiations.