Managed Care Advisory Services
Helping healthcare provider organizations evaluate compensation and secure competitive reimbursement rates.
Managed Care Advisory Services
Michael J. Patti
Principal
The healthcare landscape is evolving rapidly, with providers facing increasing pressure to optimize reimbursement, comply with regulatory changes and deliver high-quality care while managing costs. Navigate managed care confidently with Baker Tilly.
Ensuring competitive compensation and the enforcement of best practices is vital when negotiating reimbursement rates with payers and managed care organizations (MCOs). Successfully navigating managed care requires a strategic approach that aligns financial sustainability with operational transformation.
Why managed care matters
Healthcare organizations must balance complex payer relationships, shifting service models and evolving reimbursement structures.
Price transparency & compliance
Adapting to federal regulations while ensuring competitive, sustainable pricing.
Alternative payment models & value-based care (VBC)
Transitioning from fee-for-service to value-based contracts while managing financial risk.
Data-driven decision making
Leveraging analytics to optimize payer negotiations, pricing strategies and operational efficiencies.
Market evolution & uncertainty
Adapting to outpatient care growth, shifting reimbursement trends, and regulatory updates.
Solutions to explore
Reimbursement strategy & benchmarking
Optimizing contracts, aligning pricing and enhancing financial sustainability.
Without clear benchmarking, organizations risk misaligned managed care rates, inefficient contract negotiations and lost revenue. A data-driven approach helps providers optimize contracts, refine pricing strategies and improve financial sustainability. Key strategies include:
- Contractual language review to align with payer expectations and protect and enhance revenue streams.
- Benchmarking managed care performance to assess service line margins and reimbursement competitiveness.
- Fee-for-service (FFS) contract assessment to ensure sustainable and equitable payment structures.
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Value-based care optimization
Structuring risk-based models and optimizing performance.
As organizations transition to value-based care (VBC), aligning financial sustainability with quality outcomes becomes critical. Providers must optimize payment models and implement strategies to improve patient care while maintaining profitability. Approaches include:
- Assessing risk-based payment models to ensure financial viability and contract sustainability.
- Bundled and episodic payment strategies to drive efficiency and care coordination.
- Physician integration strategies to enhance provider alignment and demonstrate value to payers.
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Data analytics & price transparency
Leveraging market intelligence to improve negotiations and ensure compliance.
Data-driven insights are vital for navigating regulatory compliance contract negotiations, and market positioning. Organizations need real-time intelligence to make informed decisions and remain competitive. Strategies to enhance transparency and analytics include:
- Analytics to ensure compliance with federal price transparency laws.
- Leverage price transparency data to measure market competitiveness amongst peers and support contract negotiations.
- Predictive modeling and reimbursement forecasting to anticipate market shifts and optimize pricing.
- Tracking and monitoring contract performance to ensure alignment with financial and operational goals.
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Tailored solutions for success
Baker Tilly provides a full range of managed care consulting solutions that are customized to fit the individual needs of our clients and that can help providers quickly adapt and transform their strategy, operations and reimbursement structures to remain competitive and viable in an evolving market.
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Our professionals
Our managed care consulting team brings deep expertise and hands-on experience to help healthcare organizations optimize reimbursement and navigate complex payer relationships. With a comprehensive understanding of industry regulations, evolving payment models and market trends, we deliver strategic guidance tailored to your unique financial and operational needs.
