Case Study: Transforming Managed Care Contracts to Drive Revenue Growth

A Strategic Approach for Accelerating Healthcare Provider Growth

Strategic Healthcare Collaborations (SHC) partnered with a top-tier healthcare provider to address their long-standing challenge of low reimbursement rates from major managed care payors. The healthcare provider, faced with stagnating reimbursement rates and administrative challenges, sought the expertise of SHC to revitalize their managed care contracts. Through a comprehensive assessment, strategy development, and strategic execution, SHC was able to achieve significant double-digit pricing increases and improve the client’s bottom line, allowing them to pursue a third location for services and overall revenue growth.

Key Challenges and Pain Points

Over time, the contracts our client initially accepted from major payors did not adequately adjust to the rising pace of inflation and increasing administrative challenges. Staffing issues and the overall complexity of doing business was becoming difficult to manage.

Faced with decisions to either stay in-network at pricing that wasn’t covering costs or improve reimbursement rates, our client recognized the need for strategic intervention to impact overall profitability and enable future growth.

“When we learned about Strategic Healthcare Collaborations’ approach and Gene’s expertise, we were one of the first to jump on board. We weren’t only looking for a quick fix, but also wanted a long-term solution for sustainable growth,” our client stated.

The Strategic Healthcare Collaboration Approach

The first step was to assess existing contracts and pinpoint the issue. This process provided valuable insights, leading to the development of a strategic contracting plan. This plan aimed to improve existing reimbursement rates and sever relationships with payors that were no longer meeting the organization’s needs.

Gene, a seasoned healthcare consultant and owner at SHC, stated this process is crucial in determining a plan. “Assessing existing contracts was methodical and led to having fact-based decision-making. I helped our client realize that we were making difficult decisions to grow the business and achieve their financial targets and continue to offer high-quality care.”

Once our client expressed complete alignment we were ready to execute our plan.

The Execution Phase

SHC proactively commenced contract negotiations with three of the client’s most significant commercial payors, undertaking a meticulous process that involved persistent follow-up efforts, often requiring direct engagement with decision-makers. Throughout this negotiation period, SHC not only advocated for necessary increases but also comprehensively presented the compelling value proposition that this healthcare provider brings to their members. This multifaceted approach aimed to demonstrate the mutual benefits of a strengthened partnership, emphasizing the quality of care, innovative services, and overall positive impact on the health and well-being of the payors’ members.

Key Results and Outcomes

Two of the three payors agreed to the client’s requests, achieving double-digit pricing increases. While the third payor initially decided against offering the desired increases, there is optimism that they may reconsider this decision.

The client attributed the project’s success to Gene’s involvement and leadership, stating that Gene was involved in every step and was a true leader for us in this process. The client also emphasized the importance of having someone with a sole focus on managed care contracting and performance.

The success of the project has positively impacted the organization, allowing them to recruit and retain the best staff and positioning them for future expansion.

The Bottom Line

This case study illuminates the transformative power of collaborative, strategic efforts in reshaping managed care contracts and driving sustainable growth for healthcare providers. At SHC, we take pride in delivering results that extend far beyond immediate gains. Our commitment to methodical, fact-based decision-making, coupled with unwavering persistence, has empowered our clients to overcome challenges and achieve their long-term goals.

If your organization is navigating similar hurdles or seeking to optimize existing contracts for future success, consider partnering with SHC. Our specialized focus on managed care contracting and performance can be the catalyst for your organization’s journey toward financial strength, improved quality of care, and strategic expansion. Don’t just manage contracts; let’s transform them together for a brighter, more prosperous future.

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