Payer and Regulatory Research

introduction

Payer Contracting Strategy and Regulatory Research

At SCALE, we understand the complexity and importance of strategic payer contracting and regulatory research in today’s competitive healthcare landscape. Our integrated services provide comprehensive solutions for healthcare organizations seeking to optimize their profitability and position themselves strongly in the market. We partner with growing healthcare providers through ongoing services to respond to any payer issues.

SCALE Payer Contracting Strategy

SCALE Payer Contracting Strategy provides comprehensive payer consulting and contracting services.  Payer strategy development identifies opportunities to improve profitability and competitive position through language provisions. Our team offers integral and insightful research to help clients make the most informed decisions for all stakeholders.

We combine decades of experience working for payers, an assertive approach, and use of our extensive industry contacts to produce best-in-class results for our clients. Our analyses include research of market dynamics, opportunities for value-based care partnerships, geographic leverage, and performance metrics to maximize the outcome of the negotiation.   

In addition to supporting, organizing, and managing payer contracts, we can build and implement a Contract Management Solutions (CMS) tool – an easy-to-use digital repository of all payer contracts with support for related business functions. Recurring professional services are also provided to support on-going payer contract management.  

Initial Assessment
  • Thorough contract review
  • Market analysis using price transparency data
  • Rate and service comparisons based on your specialty
Strategic Negotiation Support
  • Contracted reimbursement and revenue modeling based on utilization.
  • Payer strategy development and targeted recommendations
  • Collaboration and leadership during payer-provider negotiations
Contract Maintenance and Professional Services
  • Build, set – up and maintain Contract Management Solution (CMS) tool
  • Contract renewal management.
  • Periodic payer contract strategy development due to market or provider changes.
  • Payer dispute resolution

More Information About
Our Contract Management System Tool Here

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SCALE Regulatory Research

SCALE’s Payer and Regulatory Research services examine CMS trends, Congressional legislation, and value-based care innovations to inform your business.  Additionally, we provide landscape analyses that identify opportunities in healthcare across the country, offering integral and insightful research to make the most informed business and investment decisions. Clients can utilize our research capabilities when considering expansion into new markets through de novo clinics, acquisitions, or when evaluating the impact of new healthcare policies.

Client Profile

  • Services Deployed:
    MSO & Practice Integration
    Payer Strategy
  • Specialty:
    Orthopedic
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CASE STUDY:

Orthopedic MSO Case Study – Payer Contracting Strategy

SCALE was engaged by an orthopedic Management Services Organization (MSO) group to assist with payer contract review, contract strategy development, and contract renegotiation with multiple payers across their Commercial and Medicare Advantage (MA) lines of business.

The SCALE Difference

We utilize our extensive national network to give our clients an accurate outlook and overview before deploying capital and making acquisitions in targeted regions.

Payer Research

The payer landscape can vary greatly between states. Our understanding of how payers work in different regions gives our clients an accurate understanding of the possible opportunities and challenges when forming a provider group strategy.

Employers

Employers and employer-sponsored health plans can drive growth in a healthcare market and create new business opportunities. We can help identify partnerships with employers for our clients and project an employer’s total effect on the market.

Competitive Analysis

Understanding your competitors, their services, and the market patient/client population allows for greater ability to adapt to changes in the market and strategize for the future.

Data and Analytics

SCALE utilizes commercial payer data from over 100 million covered lives, employer sponsored plans, and published state and federal reimbursement data. We combine our analysis of the data with interviews and surveys to give our clients a well-rounded view of the market.

Patient / Client Opportunities

We combine use of data with surveys and interviews to estimate opportunities with the current patient population and areas for future growth.

Regulation / Policy / Legislation

Government regulations and legislation can be an obstacle to account for in the future but also create opportunities in the market. Our deep experience with analyzing healthcare reforms allows SCALE to give an accurate view of the current environment and likely outcomes.

Click For Reading

Download our one-page fact sheet to learn more about SCALE Payer and Regulatory Research solutions.

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Click For Reading

Download our one-page fact sheet to learn more about SCALE Payer Strategy solutions.

Download Now
Click For Reading

Download our Contract Management Solution (CMS)

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