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. Our additional services that we offer provide capacity for ongoing and unforeseen payer matters as needed.
In addition, to support, organize, and manage payer contracts, we can build and implement a Contract Management Solution (CMS) tool – an easy-to-use digital repository of all payer contracts and with support for related business functions. Recurring professional services are provided to support on-going payer contract management which may include:
Users can set-up ‘action’ alert reminders such as 90-days from renewal date, need to schedule penetration test, get updated SOC audit, etc.
Built-in tracker log provides audit/ checkpoint functions to ensure all appropriate reviews are made and sign- offs are secured.
Secure application with admin oversight module to define which users have access rights to view/read/write.
Secure Access
PDFs of all Contracts/appendices
Admin Functions
Admin Functions
MS Outlook Interface
Meta Data
Export Data
Export Contracts
Define critical path sequence to secure review & sign-off of all required stakeholders. This intelligent approval sequencer enables users to:
Repository of unlimited payor contracts, amendments, and attachments such as NDA, BAA, Performance Guarantees, etc.
Links/tags for cross-referencing critical terms, pricing, effective/ expiration/recurring dates, etc.
Documents in PDFformat, convertible to Word.
Smart data entry interface prompts for key terms, conditions, critical dates, required signatories, etc.
Ability to add custom fields.
HIPPA compliant
2-factor authentication and e-signature.
Configurable user roles and permissions.
Enable users to define a custom contract sign-off sequence, including specification of dependencies and turnaround time frames.
Application integrated with MS Outlook.
Enables triggers to sent ‘Action Needed’ alert emails.
Compose, sent and receive contract related emails.
Captures user comments related to contract provisions and approval process review.
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.
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 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 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.
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.
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.
We combine use of data with surveys and interviews to estimate opportunities with the current patient population and areas for 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 analyzing healthcare reforms allows SCALE to give an accurate view of the current environment and likely outcomes.
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