Managed Care Contracting

A Value-Based Approach to Managed Care Contracting
Harpeth Consulting managed care experts assess the current state of managed care operations and executed agreements, assist clients in identifying executable improvement opportunities, and provide implementation assistance throughout the remediation and improvement process. Our experts develop improvement options that are focused on increasing net patient revenue as well as operational effectiveness. We advise our clients on all elements of contracting, including:

• Strategic planning
• Analysis and comparison tools
• Reimbursement rate benchmarking
• Contract management/modeling
• Internal controls and communication plans
• Pre-negotiation preparation

Deep Industry Expertise
Our team of managed care professionals includes former Vice Presidents of Network Management, Directors of Managed Care and career consultants. We advise a wide variety of clients from large hospital management companies, academic medical centers and the federal government to community hospitals, physician groups and ancillary service providers.

Managed Care Contracting Review and Implementation Assistance
We begin by assessing the managed care strategy and contracting infrastructure. Then we assess the status of significant agreements and:

• Compare negotiated rates among existing agreements, Medicare and average area commercial reimbursement
• Understand business impact of key contract terms and conditions
• Determine potential improvement opportunities and related implementation plan
• Take action