A market leading academic health system was facing rising costs and an increasingly complicated set of payer relationships. The organization's leadership team sought support in developing a comprehensive, long-term payer strategy, evaluating current pricing relative to market norms, and developing its pricing strategy.
Ridgeline partnered with the organization’s executive leadership as well as managed care and finance teams to understand current market dynamics and completed a commercial reimbursement benchmarking effort. The price benchmarking effort presented new rate targets for major commercial plans and the opportunity to recalibrate rates across various settings of care and service lines to optimize revenue. Informed by the current and desired future market positioning, Ridgeline developed a long-term payer strategy for the organization that incorporated its enterprise goals, transition to value-based care and competitive dynamics.
This engagement identified a commercial rate lift opportunity of 15-25% over three years for our client. Deploying the payer strategy we collectively developed, our client was able to achieve rate lifts in the upper end of this range. Furthermore, the organization now has its service-level reimbursement rates appropriately calibrated based on price elasticity and its level of differentiation relative to competitors. In addition to achieving desired financial results, the payer strategy helped guide the organization to support continued organic growth and position it for success in value-based care arrangements.