Provider Revenue Excellence

We partner with health systems to earn appropriate patient volume across all sites of care; ensure that payer contracts provide a fair unit price; design effective, value-based agreements; and achieve optimal yield realization through the revenue cycle for services rendered.

We bring expertise to health systems on asset-footprint strategies, clinical program and workforce development, continuity of care, and more, using a comprehensive approach to the operational activities that support appropriate volume growth.

We bring distinctive capabilities, including a focused approach to aligning contracting outcomes with operations, that enable health systems to excel along the full managed-care-contracting life cycle.

We use ready-to-deploy assets, playbooks, and practical experience across the revenue cycle to ensure optimal yield realization while maximizing important, adjacent variables, including patient experience, cost to collect, and cash flow.

A regional health system had approximately 25 percent of its patients with commercial insurance report not having an existing relationship with a primary-care provider or practice. We helped institute a process for follow-up scheduling for unattached patients after emergency-department visits, realizing a $3 million contribution gain in a pilot facility. When rolled out across the system, it contributed to up to 8% of growth over 12 months.

A large, multistate health system had flat rates of network integrity over an 18-month measurement period across its core markets. Using our referral-mapping suite, we helped the system improve its continuity of care, resulting in a 20 percent increase in in-network-consult referrals, a more than 25 percent increase in per-month visits, and contributed to over 11% of growth over 12 months.

A large not-for-profit system was struggling with high initial denials rates and high denial-related write-offs. We developed a comprehensive denial prevention program to address these issues. Data flows were established to push a subset of denials through the suite to end users to identify root causes and develop actionable solutions. Support infrastructure of denial committees and reporting analytics were implemented to manage solution deployment and track impact. In a short period of time, the client achieved a 15-20% reduction in initial denials in regions where the efforts had focused, with an expected run-rate impact of over $10M and cash acceleration in excess of $40M.

A large health system that was struggling to secure market access at rates commensurate with its value sought to improve its managed-care-contracting capability and optimize contract performance. Over nine months, we partnered with the system to transform the function, implementing a system-level-contracting capability and securing more than $250 million in incremental contract value across ten markets.