Negotiations with health plans can be challenging under the best of circumstances. In addition to the time it takes to embark on such an endeavor, it can become overwhelming to identify and organize the information necessary for negotiations and to deploy consistently a contracting strategy. Existing contract assessment, reimbursement analysis, and facilitation of the negotiation all take time and an ability to analyze information and model scenarios on a real-time basis. In addition, new value-based payment methodologies present very different scenarios for providers to consider. We can help you identify where you want to be on the managed care contracting continuum and provide the necessary support to get you where you’re going.
Here’s how we can help:
Managed Care Contracting – Work Streams
Successfully shifting from fee-for-service to value-based methodologies requires getting your house in order:
- Understand current contract performance.
- Appreciate market conditions:
- Payers
- Employers
- Referral base
- Patients
- Networks
- Alternative payment models
- Articulate mission and goals.
- Outline practice attributes – services, geography etc.
- Define critical questions getting to the heart of the matter.
- Identify negotiation team including business and clinical perspectives.
- Plan approach including timing and deal breakers.
- Determine your value proposition clearly, concisely and quantifiably.
Value Proposition
We work with providers to identify where you want to be on the managed care contracting continuum and provide the support to get you where you’re going.
Managed Care Contracting – Strategy
A key work stream in our process involves a deep dive around how your payer partners, patients and referral sources view your practice:
We can also help identify APM possibilities such as Advanced APMs in CMS’ Quality Payment Program:
Advanced Alternative Payment Models (APM)
Initial Advanced APMs:
- Comprehensive Primary Care Plus (CPC+)
- MSSP Tracks 2 & 3 and Next Gen ACO
- Oncology Care Model Two-Sided Risk
- Comprehensive ESRD Care Model (CEC)
- CJR & Cardiac Demo Participants (risk dependent)
We collaboratively engage with your team to knock out the ‘to do’ list that will serve as the foundation for your managed care contracting strategy. We assist our managed care contracting clients with as little or as much support as they need:
Results