Case Study

National Managed Care Organization

Value-Based Payment Optimization

Situation

  • Recent staff turnover and growth of clinical costs created need to quickly improve Managed Care insurance payment rates for Long-Term Care business
  • Managed Care discussions around Value Based Payment (VBP) required significant financial modeling and strategic assessment to ensure success of VBP program implementation
  • Numerous Managed Care plans had outstanding Accounts Receivable (AR) due to client issues and required near-term cash flow relief

SMA Services

Strategic Review

Pricing Optimization

Business Planning

Business Transformation

Actions & Impact

  • Reviewed largest patient volume and lowest rates vs. market to target initial plan for improvement discussions
  • Modeled current VBP programs and identified potential strategic opportunities to negotiate contract enhancements to improve likelihood of client success
  • Created proposals and reviewed with client to position new proposed rate structures and/or contract terms
  • Utilized client’s Plan contacts, as well as industry contacts, to position new rate proposals
  • Delivered projected revenue improvements with >80% of the Managed Care plans identified meeting or exceeding target market rates
  • Negotiated AR improvements and received cash commitments for aging AR

Results

$14M Annual Revenue

7% Overall Revenue Improvement

AR> 150 Days by over $5M in 6 months