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Managed Care Services
Improvement of commercial payor contracts can result in significant revenue gains for
hospitals, health systems, and medical groups. ECG has extensive experience assisting hospitals and medical
groups in managed care contract analysis, negotiation, and revenue capture. We have expertise in every step
of the managed care process, from defining the contracting strategy, to modeling the revenue impact of
contract terms, to negotiating contracts and resolving payment disputes. The result of these projects is
often millions of dollars in extra revenue.
We can provide assistance with specific components of the managed care cycle or serve as the
managed care department for the hospital. Specific areas in which ECG
consultants can be of assistance include:
- Contract modeling, analysis, and language review.
- Negotiation and negotiation support.
- Managed care strategy development.
- Rate benchmarking.
- Payment compliance audits.
- Dispute resolution and litigation support.
- Operational reviews.
- Managed care structure, function, and departmental design.
As a result of our Managed Care Services, hospital clients see measurable gains in their income.
We currently provide Managed Care Services to a number of hospitals and have completed multiple negotiations
resulting in significant revenue increases for our clients:
- We secured a 35 percent reimbursement increase over 15 months from a major commercial payor for a 280-bed community hospital.
- We helped a 1,560-bed delivery system understand its reimbursement position in the marketplace and advised on reimbursement strategies for upcoming negotiations (approximately $65 million in contracts).
- We secured a $1.3 million payment for a 170-bed hospital from a major commercial insurer due to system payment errors.
- We analyzed and negotiated contracts for employed physicians of a multihospital system, leading to a $2 million annual revenue increase.
- We analyzed revenue cycle operations for employed physicians of a multihospital system and initiated process improvements, leading to a $3 million bottom-line impact.
Following are examples of our work and our clients’ results in this area:
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Selected Projects
- Providing financial modeling support for managed care negotiations.
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.
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.
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.
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.
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