Optimizing your payer relationships

Beyond the “pay me more” strategy

The economic downturn has put significant pressure on both payers’ and providers’

bottom lines, as investment income, volumes, and collections have languished.

The unprecedented challenges are forcing providers and payers to take a more collaborative approach

to managed care contracts.

Struggling with a common set of reimbursement challenges:

• Rising administrative costs — averaging $30–60 to issue and collect a single claim.

Struggling with a common set of reimbursement challenges:

• Lack of reimbursement, cost and quality transparency, and time-consuming “data wars” with top payers regarding whose data were “better.”

Struggling with a common set of reimbursement challenges:

• No pricing strategy to address volume declines due to new competition for historically high-priced, high-margin commodity services.

Struggling with a common set of reimbursement challenges:

• Federal and state payment reform.

Struggling with a common set of reimbursement challenges:

• Bundled hospital and physician payment rates.

Struggling with a common set of reimbursement challenges:

• Shared risk/reward among payer and provider.

CRC is helping payers and providers

Take a fresh look at their managed-care contracts

Collaboratively formulate their “Pay Me Right”

strategies.