Provider/Plan Contracting

Background

Discover the art and science of effective payor/provider contracting with our team. Our invaluable expert insights are designed to help healthcare organizations forge strategic partnerships, negotiate favorable agreements, and cultivate mutually beneficial relationships.

Welcome to our comprehensive Provider/Payor Contracting Services! At CareOne Consulting, we recognize the pivotal role of effective provider/payor contracting in today's healthcare landscape, and we're committed to empowering both providers and payors with tailored solutions that optimize contractual agreements and drive mutual success.

Our comprehensive provider/payor contracting services are designed to facilitate fair and beneficial agreements between providers and payors, ensuring alignment of interests, and fostering collaborative relationships for improved patient care and financial outcomes.

Key Ways Our Clients Utilize Us:

Contract Negotiation: Leveraging our expertise and industry insights, we negotiate favorable terms and conditions on behalf of providers and payors, ensuring fair reimbursement rates, transparent payment models, and mutually beneficial contractual arrangements.
Contract Analysis and Optimization: We conduct thorough analyses of existing contracts, identifying opportunities for improvement and optimization to enhance value-based care delivery, reduce administrative burdens, and maximize financial performance for both providers and payors.
Compliance and Regulatory Support: We provide guidance and support to ensure compliance with regulatory requirements and industry standards, helping providers and payors navigate complex healthcare regulations and mitigate legal risks associated with contracting activities.
Performance Monitoring and Reporting: Utilizing advanced analytics and reporting tools, we monitor contract performance metrics, track key performance indicators, and provide actionable insights to drive continuous improvement and optimize contractual outcomes for all parties involved.

Join the ranks of healthcare providers and payors that have achieved success and sustainability in their contractual relationships with the support of our provider/payor contracting services. Let us be your strategic partner in navigating the complexities of contracting, optimizing contractual agreements, and driving mutual value and growth in today's dynamic healthcare environment.

Related Insights

5/1/24

CVS Made a Big Bet on Medicare. It’s Looking Risky

The healthcare giant cut its guidance for 2024 yet again

4/23/24

CMS Publishes Final Rule on PACE

The Final Rule gives CMS additional grounds on which to deny PACE organizations’ initial and service area expansion applications, imposes immunization requirements on staff who have direct contact with PACE participants, establishes deadlines for reviewing recommendations and scheduling services for PACE participants, and alters the grievance resolution process.

4/16/24

inVio Health Network and CVS Accountable Care Partner to Improve Medicare Patient Care in SC

It is CVS Health's only ACO REACH partnership in the state, helping advance health equity issues and address social determinants of health

4/11/24

Medicare leaders discuss accountable care growth as part of NAACOS conference

Collaboration across CMS centers and with ACO participants is key.

4/1/24

CMS finalizes Medicare Advantage, Part D payment changes for CY 2025

Few surprises or material changes from the advanced notice. Plans may see wildly different impacts based on their population and programs.

3/26/24

CMS introduces competitive bidding into the Value-Based Insurance Design program for 2025

This new guidance has implications for Medicare Advantage stakeholders as a whole and for MAOs that seek to participate in the VBID program in the future.

3/18/24

MedPAC report slammed by insurers and docs over Medicare Advantage and physician reimbursement

Health plans and providers alike are disgruntled with a new report to Congress released by the Medicare Payment Advisory Commission (MedPAC).

2/9/24

Medicare Advantage headwinds didn't prevent payers from turning a profit in 2023

Though a spike in utilization among seniors slammed payers last year, particularly in the fourth quarter, each of the six major national firms turned a profit in 2023.

2/9/24

Medicare to cap out-of-pocket spending on Part D prescription drugs at $2,000

A provision in the Inflation Reduction Act will implement a $2000 out-of-pocket cap on Medicare beneficiaries’ prescription drug spending, which could save money for more than one million enrollees when it takes effect next year.

2/1/24

Medicare Advantage RADV Final Rule

The rule implements changes to the Medicare Advantage RADV program, which CMS uses to recover improper risk adjustment payments made to Medicare Advantage plans.

1/31/24

CMS Releases Proposed Payment Updates for 2025 MA and Part D Programs

Payers up against slight decline in 2025 Medicare Advantage payments

1/25/24

Humana posts $541 million loss in Q4, blames high Medicare Advantage costs

Humana's stock dipped following the earnings report, prompting the organization to cut its earnings guidance for this year and next.

1/5/24

US managed care companies lagged behind other insurers, S&P 500 in 2023

Shares of US managed care carriers generally underperformed other types of insurers and the wider market in 2023

11/28/23

HHS Proposes Keeping Same Risk Adjustment Policies for 2025, With Some Exceptions

If finalized, these proposals will generally take effect on January 1, 2025, unless otherwise noted.

11/16/23

CMS releases standards and payment parameters for plans on the ACA marketplace

Changes would increase incentives to engage the American Indian and Alaska Native population, whose communities have been underserved.

11/6/23

Wins and losses in the physician fee schedule final rule

Physician pay in final rule is untenable, providers say, as they laud the delay of MIPS policy and extension of telehealth flexibilities.

10/26/23

Former HealthSun exec accused of Medicare fraud resulting in $53 mln overpayment

Prosecutors said that, in order to carry out their scheme, Valle and unnamed co-conspirators obtained physicians' login credentials to add fake diagnoses to patients' electronic medical records.

10/24/23

Three quarters of ACOs in direct contracting model earned savings

The Global and Professional Direct Contracting Model is now ACO REACH.

10/23/23

Medicare Advantage Plans Pulling Back On In-Home Care Supplemental Benefits

Specifically, across EPHRB, SSBCI and VBID authorities in 2024, 867 plans will offer in-home support services (IHSS) as a supplemental benefit, according to ATI. This is a decrease from the 1,308 plans offering this benefit in 2023.

10/16/23

How CMS’ 2024 Risk Adjustment Rules May Affect Palliative Care Companies

The impact on individual palliative care providers will largely be determined by the terms of their current agreements with MA plans and how they apportion risk between the payer and provider entities.

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