SCALE Payer Contracting Strategy provides payer contracting and strategy development support to SCALE Healthcare to providers varying in specialty, scope, and size. Through a comprehensive analysis of the current market and payer review, SCALE identifies opportunities for revenue optimization through payer contract negotiation. Our services offer thorough insights that equip your practice or portfolio of practices skillfully engage payers.
We leverage our decades of experience working with and for payers as well as industry relationships to produce best-in-class contracting results for our clients,
Our services analyze payers, areas for revenue and patient growth, reimbursement levels informed by market research, and opportunities for value-based care partnerships. Clients can utilize our services when interested in expanding into certain targeted states or regions, when examining potential acquisitions, or managing large provider group networks.
SCALE Payer Contracting Strategy is headquartered in North Carolina.
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.
Location
10 + Locations
Specialty
Pediatric
Our Client is a leading independent children’s home health care agency for complex pediatric patients. The business has long-standing relationships with payers often seen solely as a DME provider, even though services are far more extensive.
The real-world application of the No Surprises Act (NSA) has been fiercely contested by physician groups and has resulted in a much larger volume of payment disputes between plans and providers than originally anticipated. The dispute process has reshaped contract negotiations and has a growing backlog of cases for arbitrators to still decide. To implement the law, federal agencies jointly released guidance outlining how to protect patients from providers balance billing for out-of-network care. It is also important to note that many states already have their own balance billing protections in place that may apply in certain situations.
Payers can vastly differ per state despite being under the same company. Our understanding of how payers work in each state gives our clients an accurate understanding of the opportunities and challenges from payers when forming a strategy.
Employers and employer sponsored health plans can drive growth in a healthcare market and create significant opportunities. We identify partnerships with employers for our clients and project the employer’s effect on the market.
Knowing your competition, their services, and targeted patient/client population allows for greater ability to adapt to changes in the market and strategize for future.
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 very well rounded view of the market.
We combine use of data with surveys and interviews to estimate opportunities with the current patient population and likely future growth.
Government regulations and legislation can be a obstacle to account for in the future but also create opportunities in the market. Our deep experience with the government allows Scale to give an accurate view of the current environment and likely future actions.
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