Benefits of Managed Care Consultants For Healthcare Providers

Benefits of Managed Care Consultants For Healthcare Providers

Operating within the healthcare industry as a healthcare provider can be tricky and overwhelming. At any time, there are dozens of concerns that need to be juggled—many of which can change in an instant.

Sometimes to handle it all, particularly those tasks outside of your expertise, you need to rely on external assistance. This is where managed care consultants can help. These professionals support your organization’s objectives while providing an unbiased perspective. 

But that just scratches the surface of what expert, managed care consultants can do for healthcare providers. 

What do Managed Care Consultants Do? 

Before we can dive into the benefits, it’s important to first have a general understanding of the role managed care consultants play. Typically, healthcare consultants operate as a third-party adviser to a managed care organization.  

What is a managed care organization? These include:

  • Accountable care organizations
  • Group purchasing organizations
  • Integrated delivery systems
  • Independent physician or practice associations 
  • Physician practice management companies
  • Physician organizations 
  • Hospital organizations 

They offer an external view on how to best manage the various strategic challenges within the healthcare space. In particular, their goal is to optimize efficiency, find structural improvements, and help promote revenue generation. According to a Deloitte survey:

“Over 50% of participants found that third-party advisors added value during strategic assessment, business case development, RFP / vendor selection, and negotiation and contracting.”

The employee composition of a managed care consultancy includes healthcare experts from various fields, including:

  • Legal experts
  • Regulatory experts
  • Data analysts
  • Contract negotiators 
  • General healthcare specialists   

BENEFITS OF MANAGED CARE CONSULTANTS FOR HEALTHCARE PROVIDERS

Managed care consultants can support companies of all sizes as they navigate the ever-changing healthcare landscape. Top benefits of partnering with a managed care consultant include: 

Signing Better Contracts  

What is a managed care contract exactly? It is an agreement between a managed care organization (MCO) and a healthcare professional which defines the relationship from a financial and care perspective. Payer contracting is the lifeblood of the industry. But many providers run into the problem of closed networks. Often, healthcare providers approach a payer and are promptly told that “they have a preferred partner,” “the network isn’t open,” or “come back six months from now.”  

Managed care consultants don’t take no for an answer and support in negotiating managed care contracts

Additionally, the primary goal of a managed care consultant is to help you sign better contracts. It’s not simply about landing more contracts, since more doesn’t always translate to increased value. Instead, they focus on helping you track down the right contracts—those that align with your strategy, service offering, and service area. 

How do they do this?

The contracting process starts with a relationship database. Care consultants capture essential aspects of payer contract interactions. This information forms a roadmap that can be used to ascertain the most promising relationship paths. From there, by placing the right leverage, it’s possible to escalate requests to gain access to the network and secure meetings with priority targets.

Negotiating Higher Rates 

Contract negotiation is an integral way that healthcare providers can maximize their revenue. Whether you’re contracting with commercial or governmental payers, the process can be lengthy, complicated, and time consuming. There are fee schedules, reimbursement, requirements, and payer conditions to worry about. According to RevCycle there are dozens of elements to any payer contract, including: 

  • “The number of days a provider has to submit a claim after a service or visit
  • The number of days a payer has to reimburse the provider for covered services
  • Scope and list of services covered by the payer
  • Reimbursement rates for all covered services
  • Claim denial dispute procedures
  • Term of contract
  • Notice periods for renegotiation and termination”

Managed care consultants help you prepare for and then get the most out of every contract negotiation. This process involves several crucial steps, including:

  • Asking the right questions – A managed care consultant team knows what questions to ask in order to fully understand the importance and relevance of each payer proposal. Questions like:
    • When is the contract up for renewal?
    • Where does most of your revenue come from?
    • What aspects of the current contract need to be changed?
    • What’s your value proposition? 
    • Do you fully understand the contract? 
    • Have you created a rapport with payers? 

As your advocates, they know how to take a balanced and professional negotiating stance, one that doesn’t cede important ground. 

  • Strategic review – An essential part of contract negotiation is understanding your place in the marketplace. A managed care consulting team helps you see where you stand according to your strengths and weaknesses, and identifies additional opportunities in contract negotiation strategies. To discover this they perform a detailed SWOT analysis, which includes key information on:
    • Revenue
    • Utilization
    • Expenses
    • Quality measurements
    • Rankings of referring physicians
    • National quality assessment programs   

Managed care consultants help you identify, flesh out, and frame your unique value 

proposition in a compelling way.   

  • Setting contract baselines – It’s difficult to know what rate to shoot for. Many healthcare providers lack the requisite expertise to find that sweet spot. As a result, money often gets left on the table. Managed care consultants conduct a detailed financial analysis of healthcare providers’ books to find the break-even figure. This number is then used as a negotiation launching point as the two parties move toward their target goal.  

Expanding Your Team 

Often, healthcare providers are forced to manage their contracts despite not having the expertise, time, or resources. In fact, according to a Healthcents survey, more than 55% of provider organizations say that they lack the proper resources necessary to adequately handle payer contracting. 

Healthcare providers of all shapes and sizes can augment their team by enlisting the services of managed care consultants. An advisory team can support your organization at any stage, whether you want them to focus on contracting or to integrate with the entire organization. Their mission is to provide value and ROI from the outset. 

Why do so many healthcare providers rely on outsourcing? 

  • Full-time teams are costly – Finding and then hiring a full-time team is not cheap. Simply locating qualified candidates is a time consuming and costly process, let alone finding the right ones—those that will fit your team’s culture. On top of that there’s further costs such as training, benefits, and bonuses, as well as other extraneous costs.   
  • It creates specialization – When employees are stuck performing tasks that they weren’t originally hired to do, it’s often a waste of resources. It’s much better to free up employees to work on the tasks that they’re skilled at. This optimizes work flows and creates efficiencies throughout the company. In addition, it keeps employees motivated and happy since they’re not stuck handling something they’re not fit for. 
  • They come fully equipped – Managed care consultants can hit the ground running. There’s no time wasted, since they have the talents, knowledge, and tools necessary to handle the job.

Whether you need a temporary stop gap or a permanent bridge, managed care consultants are flexible; they shape themselves according to your organization’s staffing needs. 

PROVIDING AN OBJECTIVE, BIG PICTURE PERSPECTIVE

Often, when employees and leaders are caught up in the day-to-day milieu of company operations, it’s easy to lose perspective. Managed care consultants offer an unbiased, external vantage. Their judgment isn’t clouded by office politics, goals, or myopia. 

Care consultants are able to enter an organization and give their advice without fear of backlash or standing. This freedom empowers them. They’re able to guide a healthcare provider and help them formulate a strategic vision and goals. In addition, their fresh eyes allow them to see things that others within the organization may not. According to Dr. Lawrence Kindo:

“Since consultants work with them, they can see how everything is done while implementing changes to improve it. Sometimes, it can be changes to the most trivial or mundane activities that can bring about dramatic improvements. Since we all know money talks, the importance of increasing the business side of things cannot be underestimated.”

The value of having someone working with your organization who isn’t beholden to its rules and orthodoxies can’t be overstated. It can help prevent the “Emperor’s new clothes” type of situation from occurring. That could save you a lot of money over the long haul. 

A Long Established Track Record 

So much of the healthcare industry contracting lives or dies because of relationships or lack thereof. 

Managed care consultants have a long and hard fought track record of success within the industry. They’ve established relationships with payers and other industry experts, which they can then leverage to help you achieve your aims.  

Particularly when it comes to contract negotiation, having pre-established relationships offers you a significant advantage. When both sides are able to see eye-to-eye—even when they’re in opposition to one another—it’s much easier to reach a compromise. It prevents hostility and ensures that cooler heads will prevail.

Building relationships takes time and concerted effort. With a managed care consultant at your side, you get to skip those steps and immediately reap the benefits of the relationship without having to do all the legwork. 

HEALTHCENTS MANAGED CARE CONSULTANCY

There are myriad benefits of enlisting the services of a managed care consultancy such as Healthcents. Whether you lack the requisite expertise, resources, or time, we can assist with:

  • Finding newer, more rewarding contracts 
  • Negotiating better rates on both your new and existing contracts
  • Creating value and competitive advantage via outsourcing
  • Offering an unbiased perspective 
  • Leveraging our long-established relationships and track record of success 

At Healthcents, our goal is to be your managed care contracting solution. We help providers strategize, advocate on their behalf, and drive growth. With over 25 years in the business and experience in 50 states, when you work with us, you’ll see immediate ROI. 

Want to see how? Reach out to find out more.  

Sources:

Deloitte. Deloitte’s 2016 Global Outsourcing Survey. https://www2.deloitte.com/content/dam/Deloitte/nl/Documents/operations/deloitte-nl-s&o-global-outsourcing-survey.pdf

RevCycle Intelligence. Maximizing Provider Revenue with Payer Contract Management. https://revcycleintelligence.com/features/maximizing-provider-revenue-with-payer-contract-management

Medical Island. The Importance of Healthcare Consulting. https://www.medicalisland.net/medical-news/the-importance-of-healthcare-consulting