SCALE Case Study:

Payer Strategy – Behavioral Health MSO

Client Profile

  • Size:
    11 practices
  • Specialty:
    Behavioral Health MSO

Services Deployed

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Payer Strategy

Market Analysis

Overview

SCALE was engaged by a Behavioral Health Management Services Organization (MSO) to assist with payer contract review, contract strategy development, and contract renegotiation with multiple payers across their Commercial lines of business.

  • The Client is a Behavioral Health MSO with 11 practices across 14 states.
  • MSO is expanding, adding new affiliates.
  • The Client retained SCALE to increase efficiencies in payer contract review and renegotiation for their groups to improve profitability.

Execution

Phase 1 – Strategic Development:

  • SCALE Payer Strategy evaluated 31 Total Contracts.

Phase 2 – Renegotiation:

  • Thirteen contracts moved to Phase 2 which were eligible for renegotiation.
  • Eight contracts added at the request of the Client.

SCALE developed an extensive payer negotiation strategy based on market considerations
for each behavioral health practice.

  • Completed an in-depth analysis of contracted rates and contract terms, e.g., current rates relative to a Medicare benchmark.
  • Completed rate comparisons across payers and a financial analysis on the net impact review of current versus proposed rates.

Results

As a result of SCALE’s assistance in payer negotiations, the group secured significant increases in
their Commercial rates.

  • Secured reimbursement rate increases in the Commercial line of business, resulting in a combined six-figure lift across several practices
  • Accomplished improvement of contract terms.

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