Managed Care Contract Analysis for Value-Based Payment

Managed care contracting is a priority in value-based payment (VBP) agreements. 

Before attempting a VBP agreement with a managed care organization or setting up a VBP linkage relationship, you should have a comprehensive understanding of negotiated rates and payer mix.

  • Understand the risk management issues that impact outcomes and are related to your client population.
  • Define and develop a strategic book of services/products that optimizes the expected outcomes for reimbursements.
  • Analyze claim history with current services to contain revenue cycle impact of new services and new contracts.
  • Identify risks for denials and provide management infrastructure to contain and maximize service growth and relationships.
  • Analyze current contracts well before they expire because a managed care negotiation is not a quick process and will, more than likely, require multiple conversations.
  • Be prepared that new services or products may impact current contracts that may be terming.

Our managed care consulting team has years of experience in managed care contract analysis for both adult and children services.

Individual contracts can be reviewed and recommendations will be offered regarding rates, next steps in provider negotiations and alignment with VBP. All teams and projects are tailored to your specific service targets and products.

SAE is pleased to announce a lead expert in managed care contract analysis:

JOSEPH MARAFITO, MS

CONSULTANT ADOLESCENT, DISABILITY AND SUBSTANCE ABUSE

Over 20 years of progressive supervisory, program development and administrative experience in both the public and private sectors. Expertise in program evaluation, public policy, fiscal management, revenue enhancement, program development, regulatory issues, residential and community outpatient services. Worked with executive and legislative branches of government through policy committees and workgroups advising branch administrators on system development and policy related matters. Accomplished significant population reduction over a two year period at the beginning of the deinstitutionalization movement in CT, developed agency in CT that provided community based services and eventually lead to the first supported living program in CT, co-wrote and negotiated substance abuse grants and transitioned adult residential program to adolescent residential and out-patient services.

To connect with our team, call (212) 684-4480 or email info@saeassociates.com.