Changes to payment methodologies and a growing focus on transparency and consumerism all contribute to a complex healthcare reimbursement environment. When also adding the intricacy of working with third parties to outsource procedures, clinical billing or insurance filing claims in today’s evolving environment, providers should be innovative in their partnerships to improve efficiency, continue to provide the highest-quality patient care and position themselves for long-term success.
DHG Healthcare’s Payor Strategies Group works with our clients to negotiate innovative contracts between providers and third parties to ensure they receive the best price and quality possible. Our team stays up to date on any and all legislative changes that impact the healthcare industry and are on-call to assist clients in understanding how legislation may change their contracts and best practices going forward.
DHG provides an overall assessment of the provider’s top managed care agreements, develops a playbook with best practices and helps design the appropriate contracting model, including value-based provisions, that best achieves the organizations' objectives.
DHG Healthcare's Rate Benchmarking tool provides vital information within your markets to identify financial opportunities for your organization across payers and specialties. Utilizing Truven Health Analytics Reimbursement Benchmarks, the tool provides a snapshot of your financial performance by comparing your contracted rates with market benchmarks. By tailoring the model to your organization and market, the Rate Benchmarker offers actionable data at aggregate, specialty and procedure levels. This offers critical insight into how various fee structures are performing and equips your organization to make targeted improvements to managed care contracts.
DHG can help providers adapt to pricing transparency, benefit plan design and growing consumerism by identifying strategic pricing for commoditized offerings such as lab and imaging by:
With the variability in payment streams and contract requirements under value-based agreements, many organizations today are challenged to validate whether the revenues being paid are complete and accurate in accordance with the specifications outlined in each value-based contract. DHG can assess the Provider's performance against existing value-based contracts, verifying incentive payments received from payers, and help design internal processes, protocols and controls to be able to internally verify value-based contract incentive payments in the future.
Utilizing the Market Assessment and Strategy deliverable and roadmap, DHG can provide exceptionally experienced individuals to provide managed care contract negotiation and financial modeling of the agreements. Execution of this strategy can drive improvement in net revenue and margins across the managed care portfolio.
Our Payor Strategies team has a combined 55+ years of experience in various healthcare leadership and consulting roles within health plans, large hospital systems and physicians’ practices. This direct experience in payer contracting, practice management, reimbursement analytics and network development uniquely positions our team to support our clients in the areas of managed care strategy, implementation and monitoring needs.
Whether supporting payer contracting for mid-sized physicians’ groups or collaborating with health systems to develop transformational managed care/value based contracting strategies, we bring the unmatched expertise, understanding, and creativity required for the journey to risk capability.