Our mission is to enhance our clients' managed care reimbursement. Our goal is to closely align our incentive with our clients', often, a portion of our fees are at-risk. We combine an innovative approach with experience and a commitment to results...our clients' advantage, maximized reimbursement.
Case Study - Specialty Physician Corporation
Assignment:
The Managed Care Contracting Division of Carlisle and Associates was retained by a regionally recognized leader in cardiac medicine and surgery. The physician corporation had not received rate increases from its largest commercial insurance payor for a period of seven years - even as the cost of delivering care had risen steadily.
Carlisle's Managed Care Contracting Division assumed responsibility for the negotiation of a new replacement contract with terms satisfactory to the physician partners. Throughout the course of the assignment, the negotiating team was charged with the challenge to bring an unresponsive payor to the negotiating table, in an effort to enhance the client's HMO and PPO reimbursement rates.
Underscoring Carlisle and Associates' commitment to maintain aligned incentives with its client, Carlisle assumed a contingency-based fee structure - the firm’s fees were directly linked to its ability to increase its client's reimbursement rates and gross revenues.
Client Profile:
The provider was a large specialty physician corporation, recognized by leading industry analysts for its excellence in clinical outcomes. Its coordination of care in the region results in savings for all managed care payors that it contracts with. However, its reality is one of continuous cost increases that are directly related to the delivery of service to HMO and PPO subscribers. In order for the physicians to continue to deliver and ensure superior care and attract top physician talent, reimbursement had to be maximized. Prior to partnering with Carlisle's Managed Care Contracting Division, the payor's reimbursement was not representative of the participating physicians' value in the market, nor the level of care being provided to the payor's subscribers.
Contract Delivered:
Carlisle's Managed Care Contracting Team was not only successful in speeding the negotiations process, the physician corporation's leadership executed a multi-year replacement provider agreement, resulting in dramatic double-digit revenue enhancements. It is accurate to characterize the contract delivered as both the largest single year increase and multi-year increases ever negotiated by the physician corporation since its formation.
Conclusion:
Through partnering with Carlisle and Associates the physician corporation accessed innovative negotiating strategies that delivered dramatic revenue gains. In addition, it sent a distinct message to all commercial insurance payors that the corporation's reimbursement had to be commensurate with the quality of care being provided. The Managed Care Contracting Team, on behalf of the client, has since renegotiated all of the practice’s largest payor agreements.