Payer Contracting Full Support
Let's identify where you want to be on the payer contracting continuum and provide the support to get you where you’re going.
Transform Your Contracts, Amplify Your Revenue
Navigating the complexities of payer contracting can be challenging. But with Prosper Beyond as your partner, it becomes an opportunity for growth. Our tailored payer contracting solutions are designed to help healthcare providers like you unlock new revenue potential, optimize reimbursement rates, and foster collaborative, value-based relationships with payers.
From renegotiating outdated terms to securing multi-year agreements, our expertise empowers your organization to achieve sustainable financial success while minimizing administrative burdens. Let us guide you in transforming your payer contracts into powerful assets for your business’s future.
Payer Contracting – Key Work Streams
Is your practice ready to take back control over your revenue stream? Do you need full support in negotiating your contract? Deploying a successful payer contracting strategy requires a structured, methodical approach. Our framework ensures readiness for deploying a contracting strategy that aligns with practice goals in terms of economic impact and successful shifting to value-based contracting if desired.
Here’s how we optimize your payer contracting strategy:
Evaluate Current Contract Performance
- Evaluate Current Contract Performance
- Review current arrangements
- Assess contract value through financial modeling of current contract reimbursement rates
- Evaluate performance based on multiple payer contracting Key Performance Indicators
Analyze Market Conditions
- Payer market position
- Employers implications
- Referral base landscape
- Aggregator potential
Assess Alternative Payment Models
- Assess potential partnership possibilities
- Determine the feasibility of models
- Identify effort necessary for success, including reporting requirements
Clarify Payer Contracting Strategic Goals
- Establish a contracting rhythm to keep your practice ahead of the curve
- Determine where you see your practice in the future and build a plan to get there
Create Your Practice Value Proposition
- Identify key indicators that will resonate with payers
- Work with your team to craft a powerful narrative that will showcase your value
Determine Your Reimbursement Proposal Position
- Utilize publicly available data, key performance indicators, and existing arrangements to establish you reimbursement ‘bar’
- Create proposals that capture all of of your goals
Project Manage the Negotiation Process
- Communicate with payers
- Evaluate proposals and craft draft responses for your consideration
- Work with your practice and payers to establish a mutually beneficial relationship that makes sense for all parties involved
Establish a ‘Go Forward’ Payer Contracting Rhythm
- Establish your payer contracting cycle and work on negotiations proactively so you stay ahead of the curve
- Assess new arrangements as they emerge and provide valuable insights
- Work with your practice in supporting the termination process if a relationship is ending
Who we serve
At Prosper Beyond, our clients are diverse healthcare providers and organizations dedicated to delivering exceptional care. Our expertise lies in helping these providers navigate the complexities of payer contracting and achieve sustainable growth while focusing on what matters most—patient care.
- Primary care practices
- Multispecialty medical practices
- Single-specialty medical practices
- Ambulatory Surgery Centers
- Ancillary providers
- Federally Qualified Health Centers
- Rural Health Centers
- Hospital-based medical practices
- Physician Hospital Organizations
- Clinically Integrated Networks
Dr. Julia Warren-Ulanch
Creedmoor Centre Endocrinology
“As a business owner of a small private practice, I must be careful where to spend my limited resources. The team at Prosper Beyond has been a great investment. They have been critical for negotiating better reimbursements. In addition to being effective, it is a delight to work with them.”
Sommer Smith
Chief Administrative Officer, Great Lakes MSO LLC
“Working with Prosper Beyond has been a game-changer for us. Their expert guidance has been essential to helping us navigate the challenges of contract negotiation with ease and confidence. They’ve brought fresh ideas, practical solutions, and a highly professional approach that’s made a real difference.”
Melissa H. White
Practice Administrator, Newton Family Physicians, P.A.
“Prosper Beyond has been very good with keeping us informed on a monthly basis and even encouraging us to be confident in our services and value. I would not hesitate to keep them in our tool box. I am looking forward to a long relationship with what we consider are ‘experts’ in contracting with insurance companies.”
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, securing favorable amendment language and more. We identified new value-based arrangements and assisted in developing communication pathways with payers to continue working on relationship building and collaboration opportunities.