Payer and Provider Contract Management and Optimization
Successful managed care contracting starts with an acute understanding of your network, provider alignment and variations in cost of care.
We are experts in:
• Health plan and capitated population valuation, due diligence and risk assessments
• MSO assessments, enhancements and development
• ACO/IPA design, application, governance, implementation and launch
Our Approach
Examine current medical spend and utilization patterns to identify opportunities to enhance future performance
Managed care contract and Division of Financial Responsibility (DOFR) experience assessment
Assessment of payer contracts for opportunities to improve performance against existing contracts
Pro forma model development with adjustable variables to help clients understand costs and opportunities
