Healthcare

Healthcare Providers

Payer Alignment

Managed Care Strategy, Negotiations, Pricing & Payment Innovations

Navigant has one of the largest and most experienced teams of managed care and pricing experts in the industry. We work with many of the nation’s largest payers and providers to cooperatively:

  • Benchmark reimbursement rates, quality and access
  • Design and negotiate contracts
  • Develop new products and services that improve access, health and affordability

We have worked in over 80 markets nationally and have a very robust database of comparative cost, reimbursement, efficiency and quality benchmark data.

 

Healthcare reform poses a major threat to hospitals’, physicians’ and payers’ historical ways of doing business. Health insurance exchanges, accountable care and overall scrutiny of the industry are forcing all parties to “bend the trend.” Concerned about patient health and safety, more and more payer and provider clients have begun to explore the merits of working together to improve affordability, access and quality – as well as their margins.     

Services

Navigant utilizes an analytically driven approach, along with the input of seasoned clinicians, operators, managed care negotiators and financial analysts to assist providers and payers design, negotiate and implement contracts that help them compete in increasingly challenging markets. Our core services for managed care pricing and negotiations include:

  • Assess hospital & physician market position based on key variables such as unique services offered, quality of service, outcomes, competition, payer mix etc.  
  • Benchmark hospital and physician reimbursement prices, rates and costs (at a DRG and CPT level) to competitors utilizing Navigant’s databases of publicly available market specific data.  This allows us to objectively plot “price” vs. cost vs. quality vs.  “value” in a way that patients, purchasers and payers can relate – and explore new ways to achieve margins in a difficult top line environment.
  • An array of various value-based contracting arrangements that achieve different unit reimbursement, cost, volume and mix scenarios, and overall margin targets for both payer strategy, health systems and physician groups:
    • For which services will patients pay an above market price for, which allows the provider to drive margin through higher prices?
    • For which services must cost reduction drive margin?
    • What new services and/or populations should be pursued to improve margin and share?
  • Develop negotiation strategy & tactical “game plan” and, when requested, ongoing negotiation support  
  • Accountable Care White Paper

  • Hospital Consolidation Outlook Surviving in a Tough Economy

  • Payment Reform, Accountable Care, and Risk Early Lessons for Providers

 

Experienced Team

Navigant has successfully provided managed care pricing and negotiation support nationally to community hospitals, hospital and physician networks and large academic medical centers – as well as select payers that desire to work with providers to bend the trend/improve quality.  Our clients benefit from:

  • Improved relationships with their respective payers, providers
  • Improved stability of revenue and cost streams through implementation of competitive rate structures including shared savings arrangements, pay for performance bonuses, etc.
  • New services and programs that address areas of unmet need (e.g., telemedicine, home health, case management services for particular chronic conditions, etc.)
  • Development of  defensible and competitive rates and pricing
  • Reductions in administrative costs
  • Assessment and development of ACO initiatives

For more information regarding how our healthcare experts are helping organizations improve managed care and pricing in the era of health reform, read our various papers on the subject. 

CASE STUDY:

Coordinated Medical Management
A large growing health system engages Navigant’s Managed Care Strategy Services. Previous to the Navigant team’s involvement, the health system was generating the majority of its margins from one dominant payer and a handful of non-differentiated services, in a highly fragmented, competitive metropolitan market. Navigant was instrumental in negotiating with the payer to design a multi-year contract to access a large block of new patients and improve alignment between its hospitals and independent medical staffs around quality, access and efficiency. As a result, an updated fee schedule was developed that pays the provider for services which improve patient’s outcomes, along with quality bonuses that reward both quality and cost savings. Quality of care for many of the sickest patients improved via coordinated medical management activities. The hospital benefited from increased market share penetration and closer alignment with the area’s largest payer.

See Navigant's Health System Strategy services.

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