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Mountains

Fee For Service Payor Contracting

Our Solutions to Payor Contracting Challenges

Disparity in Bargaining
Power

Lack of Market Knowledge

Unfavorable Fee
Schedules

Limited Access to Payor Leadership

Complex Contracts with Onerous Provisions

Internal Resources

Typical Medical Group Challenges

Payor have significant market influence and are adept at delaying or halting rate negotiations.

Groups have limited or no insight on rates provided to the market and competitors.

Prevailing, Medicare, antiquated and/or proprietary fee schedules, disadvantageous localities.

Local/regional contractors unresponsive, delay decision making and create roadblocks. Lack of escalation to leadership that can be instrumental in completing a negotiation.

Contracts filled with dense legal and technical language, obscuring unfavorable terms or provisions.

Expensive to develop capabilities to achieve market leading rates.

Accretive Solutions

Successful outcomes driven by a combination of experience, market intelligence, and ability to communicate client's value proposition.

Develop view on Payor network adequacy requirements and cost impacts based on client market share and competitive landscape.

Organized and actionable price transparency data provides market ranges and specific to comparable medical groups.

Negotiate fixed fee schedules or offsetting escalators; quantitatively select ideal base fee schedule with minimal ability for Payors to alter or update rates.

Long standing relationships with national BUHCA executives and maintain a network of regional leadership and local contractors.

Decades of contracting experience provides extensive knowledge of contracting terms and strategies.

Efficient use of capital and time with immediate access ex- Payor executives, analytics team, data and processes.

Accretive Health (18) 1

Contracting Process

We create value for specialty and primary care medical groups by accelerating revenue and EBITDA growth

Step 1

Contract Prioritization

Build timeline of contracts to address according to:
 

  • Volume and Revenue: apply 80/20 rule, prioritize contracts driving material revenue and volume.

  • Rate Economics: prioritize contracts with below-market rates, determined by triangulating price transparency data and analysis of medical group procedure-level transaction data.

  • Age of Contract: prioritize contracts in evergreen renewal status or approaching notice period to ensure contract does not "lock up" to prevent negotiation. 

Step 2

Determine Target Rates; Revenue Projections

  • Determine Target Rates and Fees Schedules: Develop view of market and competitor fee schedules by payor, network and service utilizing payors' published data.

  • Project Revenue: Utilize CPT-level transaction data to project revenue at granular level;

    • Account for bad debt, impact of multiple procedure discounts, and other modifiers.

    • Account for fee schedule nuances; MD vs. APP, Fac vs. NF, MAC, lab, ASP, etc.

Step 3

Payor Negotiation

  • Existing relationships, past contracting experience and data cuts past payor roadblocks.

  • Articulate medical group value and market positioning.

  • Develop Term Sheet: Template term sheets for each BUCHA payor in material states which address payors’ nuanced approach to contracting.

  • Develop Rate Sample: Develop compelling data-driven position utilizing price transparency data with citations and links to payor reporting source file.

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