Leveraging “What-If Analysis” Helps to Avoid $12M Loss
Difficult to Analyze Impact of Payer Proposals
Providers often enter payer negotiations lacking adequate tools, information, and analytics to assess the financial impact of rate changes and term proposals. This often results in suboptimal contracted rates and lower reimbursement. Moreover, without the ability to quickly model the financial impact of contract terms, providers may not know if their counter-proposals will be favorable or at least neutral.
When a medium-sized health system was renegotiating their contract with their largest payer, the payer proposed changes to terms and rates that were intended to be “net neutral.” In the past, this organization would have had to manually analyze the contract proposal. This process required multiple analysts and several weeks, limiting the organization’s ability to quickly respond to changes in contract terms.