Contract Analysis & Negotiation
Hospitals, health systems, and medical groups have seen remarkable changes in the scope, importance, and complexity of contractual arrangements with private insurance companies and government payors. While maintaining market share was once the dominant concern, healthcare providers must now focus on maintaining profitability in the face of mounting complexity and a rapidly changing reimbursement environment. Your success in establishing an appropriate managed care strategy and negotiating health plan contracts that serve the ongoing needs of your organization is now a critical success factor. ECG understands the intricacies of this environment and has the experience and analytical tools to serve as your guide in securing the best possible results from third-party contracting.
Our sophisticated modeling of your existing or proposed contracts ensures that decision makers understand the financial and operational impacts of your existing contract portfolio as well as the implications of new contracts and/or proposed changes. We work to maximize the profitability of each contract. Our services include:
- Assessment of market position.
- Formulation of managed care contracting strategy.
- Contract analysis and language review.
- Rate benchmarking.
- Development of strategy for specific contract negotiation.
- Negotiation and negotiation support.
- Implementation and data management support.
ECG is a compelling choice for your consulting needs for a number of reasons:
- In-depth knowledge of provider contracting, including complex reimbursement terms, adjudication rules, and trends in public and private payor policies.
- Extensive experience with the full range of provider organizations, in all areas of the country, with all major payors.
- Highly sophisticated analytic methodologies, including modeling of contract performance to identify underperforming contracts and services within each contract.
- Demonstrated success in working effectively with all national insurance companies.
Selected Projects
Providing financial modeling support for managed care negotiations. Expand Minimize
ECG provided financial modeling support for managed care negotiations and served as a strategic adviser on managed care matters for several community hospitals in different regions of the country. Financial modeling support included developing the reimbursement model for the contract negotiations and performing supporting analysis as needed for successful contract negotiation. Strategic support included analyzing the hospitals’ portfolios of contracts, providing advice for short- and long-term strategic reimbursement planning, and providing specific reimbursement advice during health plan negotiations.
Serving as the managed care department for a health system. Expand Minimize
ECG fulfilled the managed care contracting function for a health system and its joint venture ambulatory surgery center, which included negotiation and analytical support of all managed care contracts, strategy development, and provision of managed care operations advice.
Serving as a strategic adviser to a multispecialty clinic and health plan. Expand Minimize
ECG served as a strategic adviser to a multispecialty clinic and its physician-owned health insurance plan. As part of our work, we developed a payor contracting strategy, which was needed to address current and foreseeable issues, promote adequate access to patients, and prevent the establishment of contracts that undermine the position of the clinic’s health plan.
Providing managed care litigation support for dispute resolution. Expand Minimize
ECG provided analytical and negotiation support to a health system for resolution of a dispute between the hospital and one of its major payors. This included performing detailed analysis of payment variances, drafting an expert witness report, providing technical support to legal counsel, and assisting with settlement negotiations. The result of this engagement was a multimillion-dollar payback from the payor.
