Faced with a 22% decrease in discharges between 2012 and 2014, driven by a variety of market factors, IIAR spent the next two years working to rebuild volume. However, its mixed contracting model—a combination of in- and out-of-network status with major payers—limited its ability to provide services to some patients as payers began restricting authorizations for out-of-network providers. Securing in-network agreements with additional payers was challenging because the responsibility for establishing and maintaining contracts for IIAR’s services was split across three entities with limited expertise in contracting for addiction medicine services. The complicated managed care process created operational challenges, contributed to a general sense of uncertainty among staff, and impeded IIAR’s ability to secure new agreements and negotiate increases to existing agreements.
ECG’s managed care team worked closely with IIAR leadership throughout the assessment process to create a detailed managed care strategic roadmap that specified target reimbursement levels for IIAR’s future payer negotiations. The roadmap also included an infrastructure plan to ensure the managed care contracting function would continue to be supported on an ongoing basis.
ECG was then asked to collaborate with the UnityPoint system managed care team to secure new in-network agreements and lead negotiations with high-priority commercial payers. As a result of the negotiations, IIAR realized reimbursement rate increases ranging from 5% to 21% and established new in-network agreements with two major commercial payers.
