Client Success Stories
At Prosper Beyond, our clients’ achievements tell the story. Each success story showcases how healthcare providers have transformed their practices, strengthened payer relationships, and unlocked new revenue potential.
Payer contracting case studies
From securing favorable payer contract terms to optimizing revenue cycle performance, our clients have leveraged our adaptable expertise to reach their goals and beyond. Discover how our real-world solutions and tailored strategies, designed to adapt to the rapidly changing industry, have empowered healthcare leaders to elevate their impact and drive sustainable growth. We’re proud to share these milestones as a testament to the transformative power of informed, strategic payer contracting.
Case Study
Prosper Beyond revamped payer contracting for an FQHC, renegotiating outdated contracts and transitioning to FQHC-specific methodologies. By analyzing 24 contracts, increasing reimbursement rates, and securing multi-year agreements, Prosper Beyond delivered over $1.1 million in added commercial revenue, enhancing financial growth and payer relationships.
Federally qualified health center (FQHC) had not renegotiated payer-contracts in over 10 years. The group needed to migrate existing Medicare Advantage contracts and Medicaid contracts to FQHC methodology and also request increases from payers for commercial products. Additionally the group needed to address below market behavioral health contract rates as well as dental network reimbursement.
Analyzed contracts (24 in total) in detail creating a comprehensive assessment outlining contract value to the organization, administrative burden implications and a roadmap for renegotiation strategy. Created a succinct and impactful value proposition outlining key areas pertinent to each payer and met with payers to relationship build and work on increasing contract value in terms of rates and decreasing administrative burden. Approached all strategically impactful payer contracts and renegotiated rates successfully securing many multiple year agreements with the majority payers and identified new value-based programs available to the group. The group also terminated a few agreements that were underperforming when payers did not meet reasonable market rates.
Annual economic impact = over $1.1 million estimated increases to commercial reimbursement rates. Successfully migrated Medicare Advantage contracts to FQHC arrangements. Negotiated favorable contract terms with commercial payers, increasing filing limits, and securing favorable amendment language and more. Identified new value-based arrangements and assisted in developing communication pathways with payers to continue working on relationship building and collaboration opportunities.
Additional success stories
Physical Medicine: 1 MD
Received payer amendment from practice stating that rates would be reduced by -30%, group had 30 days to respond - terminated the product to reduce the loss.
Dermatology Practice: 6 MD / 3 APP
Renegotiated 4 major payer contracts and 1 minor resulting in estimated increases adding $617,788 to the bottom line and improving contract language provisions including limiting recoupment timelines.
Family Practice: 5 mD / 5 APP
Renegotiated renegotiated 2 major payer contracts securing increases of $260,319 with escalators in subsequent years.
Gastroenterology Practice with Endoscopy Centers
Renegotiated 3 major payer contracts securing increases of $3,208,164 and evaluated a value-based agreement which was administratively burdensome and passed on the program
Endocrinology Practice: 2 MD / 4 APP
Largest payer in the state ghosting group, secured meeting through escalation and secured $56,216 in additional revenue annually based on rate improvements.
Internal Medicine Practice: 6 MD / 3 APP
Evaluated new Medicare Advantage agreements and secured more favorable rates for APPs and assisted the group in moving from IPA agreements to direct agreements resulting in a 24% improvement over IPA rates.
Vascular Surgery Group: 2 MD
Billing company signed a contract with poor rates with a major payer, worked with all parties to elevate rates to market improving by 75% adding over $1,000,000 back to the bottom line.
