Payer Management

Anticipating Impact of Reimbursement

How does payer management impact a hospital’s revenue and margins?

Healthcare providers often lack the adequate tools, information, and analytics to understand this impact and negotiate with payers

More than a third of U.S. healthcare payments are now value based, signaling a shift from traditional fee-for-service reimbursement. Across the nation, alternative payment models (APMs) have been launched and gained traction. With the addition of more complex payment models such as bundled payments and ACOs, health systems need the right tools to negotiate for adequate reimbursement and maintain healthy margins.

To get the most out of their contracts, hospitals and health systems need to be able to analyze their revenue, cost, and margin in one system; to identify underpayments and root causes; and to understand the financial impact of changes to their terms on net revenue and margin.

How can I improve my contract negotiations with payers?

Leverage the power of the platform to drive more informed contract negotiations

Healthcare organizations are already leveraging advanced analytics to model their government and commercial contracts, calculate expected payment, and estimate their net revenue and margins in real time.

Using StrataJazz®, organizations can leverage what-if modeling capabilities to help alleviate the stress of contract negotiations. Using the tool, users can provide quick and detailed analysis of payer proposals and their impact on revenue and margin across all service lines.

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Accurately analyze contracts and reimbursement

Compare contracts for selected patient groups

Accurately calculate expected payment using EHR data for any payer, including bundled payments

Simplify modeling of all reimbursement methods by configuring custom reimbursement methodologies

Perform what-if contract analysis and margin analysis to analyze changes in reimbursement or shifts in payer mix

Accurately project net revenue and perform margin analysis

Analyze shifts in pricing to model impact on reimbursement and volume

Compare expected payment and net revenue from contract analytics to cost data

Perform break-even analysis for Medicare/Medicaid or compare any commercial payer rates