Today’s payer environment is increasingly more complex and seems to change almost daily. Payers are continually introducing new business lines with more complex value-based reimbursement models. These new reimbursement models include gain-sharing agreements or risk-sharing agreements that must be analyzed as part of the contracting process. At the same time, payers are consolidating both as organizations and in their provider panels. This often results in increased provider competition and reductions in reimbursement rates adding more pressure on an organization’s ability to succeed. Healthcare organizations must develop a contracting and reimbursement strategy that optimizes reimbursement, network access, and organizational success.
The HPS Solution
HPS Solutions has negotiated payer agreements on behalf of our clients in a variety of healthcare specialties. Our in-depth knowledge of payer plans and the contracting process enable us to develop an effective payer contracting and negotiation or re-negotiation strategy to optimize organizational financial and operational goals. We know which agreement terms are negotiable and how to avoid the dangers of unfavorable terms. The HPS Solutions Payer Contracting Solution includes:
- Developing a payer contracting strategy to optimize market access
- Conducting agreement review and analysis
- Creating a payer contract inventory that lists key contract terms, dates, and reimbursement rates
- Developing a fee schedule analysis to compare payer to payer reimbursement rates
- Negotiating agreement terms and reimbursement