The reimbursement models of commercial and government payers are becoming increasingly complex and are absorbing elevated levels of healthcare resources—not to mention there are no assurances that contracts are tenable or will lead to financial stability. 

With the emergence of value-based payment structures, previous models and tools that served organizations well for years need to be revisited. Contracting decisions must now account for a hospital, ambulatory surgery center, or medical group’s preparedness for value-based reimbursement and clinical integration along with payer readiness for administering new contract methodologies.

ECG’s roots in payer contracting run deep. Our work in all 50 states across the nation has enabled us to build relationships with major health plans in multiple regional markets. The insights and expertise we’ve acquired have shaped us to be the premier healthcare contracting and reimbursement firm in the country.

Our experts are continually honing their strategic and technical skills to successfully usher clients through reimbursement strategies, price negotiations, and methodology changes. And our ability to understand the issues that are important to both providers and payers affords us insight into the market dynamics impacting provider reimbursement, as well as the technical skills needed to manage and optimize payer revenue streams and margins.

ECG’s payer strategy and contracting engagements often include:

• Developing payer strategy
• Assessing value-based readiness
• Advising on price transparency
• Analyzing reimbursement and conducting contract modeling
• Redesigning managed care department and infrastructure
• Designing value- and risk-based payment models
• Transitioning to value- and risk-based models
• Conducting and supporting payer-provider negotiations