How competitive are your provider contracts? How do your contracts compare to your peers in other markets? How effective are your contracting efforts? Are your contracting methodologies up to date? Are you pro-actively working with providers to develop win-win contracts?
Health care provider charge levels are increasing at a higher rate today than in many years, complicating the contracting process and negatively impacting premium competitiveness. Gone are the easy contracts. The number one cause of reduced health plan profitability is higher than expected provider reimbursement. To thrive in today’s market, all health plans need to know they are getting the most favorable arrangement possible. This is even more critical as plans consider tiered networking products.
How can AHP help?
AHP has compiled extensive information to help you evaluate and assess your contracting process. Our approach is to:
- Collect your contract data with all hospitals and providers focusing on those in current negotiations
- Collect comparable market data including American Hospital Directory, State rate filing, publicly available managed care data, national data base sources including Medicode and Sachs, as well as our proprietary data
- Define market/service area boundaries
- Analyze market data and summarize into composite values for comparison purposes
- Summarize market data and compare to your contracts for that market
- Provide written report including a plan for future negotiations
Why Axene Health Partners?
AHP consultants have access to significant provider contracting information. We have developed an actuarial methodology to assess an organization’s competitiveness, including an adjustment for case mix, severity and efficiency which can be used for rate modification for some provider contracts. This resource adds significant value to your provider contracting comparison & analysis efforts. Our multi-disciplinary consultant model provides a depth to this analysis that expedites discussions with providers.
For more information, contact us at info@axenehp.com