The Challenge

Commercial – Analytics-Based

A large carrier offering plans with an aggressive Medicare-based benefit limit sought:

  • To satisfy clients seeking greater protections from balance billing for their plan members
  • To preserve the underlying cost benefits of the out-of-network reimbursement methodology

The Solution

ĤƵ established negotiation parameters that deliver value to satisfy both payors and providers:

  • An upper limit strategically set above the benefit limit, reflecting the value of the agreement to the plan member
  • Use of the benefit limit as a floor, to quantify the benefits of agreement for the provider’s practice

The Results

ĤƵ delivers negotiated agreements with greater transparency and value for all parties:

  • A 15 point increase in savings rate
  • A less than two point reduction in success rate