Managed Care Benchmarking, Strategy, and Negotiation Support Services

The Vendor is required to provide managed care benchmarking, pricing strategy, contract evaluation, and negotiation support services.
- Services include, but are not limited to, review and assessment of current payer contracts, benchmarking of current reimbursement structure, strategy building to optimize reimbursement, and support county health in negotiations with payers to improve financial outcomes and align payer agreements with organizational goals.
- Provide data-driven reimbursement benchmarking, pricing strategy, contract evaluation, and negotiation advisory services.
- Strengthen managed care contracting and negotiation performance
- Managed care benchmarking and pricing strategy
• Perform reimbursement benchmarking analyses comparing agency rates against market benchmarks and Medicare.
• Utilize robust datasets and methodologies to evaluate pricing position, payer mix, and reimbursement trends.
• Conduct price transparency and variation analyses.
- Contract evaluation and advisory
• Perform non-legal review of payer contracts focusing on:
o Administrative efficiency
o Balance of provider vs. payer terms
• Reimbursement methodologies
• Develop a structured framework for preferred, acceptable, discouraged, and unacceptable terms.
- Negotiation Support Services
• Provide participatory negotiation support, including:
• Rate proposal development
• Counterproposal evaluation
• Meeting participation (as requested)
• Provide advisory support for contract termination strategies, if needed
- Market and Network Analysis
• Evaluate:
• Market share and payer enrollment trends
• Network retention and leakage
• Patient utilization patterns
• Identify revenue opportunities and risks across service lines and markets.