Due to regulatory changes and post-pandemic financial impacts, a national, multi-specialty medical group needed a new payer strategy fast. Historically, the organization selectively entered into highly fragmented payer agreements across the country, a strategy which was no longer proving effective. Additionally, several important leaders on the managed care team recently left the organization. The organization’s executive leadership requested support in redefining its payer strategy and negotiation approach.
Ridgeline worked with the organization’s executive leadership and managed care team to assess historical payer relations and contracting strategy. In parallel, we performed a critical rate benchmarking analysis, identifying a need to implement a transparent, market-based pricing strategy. When assessing the organization’s market position and value proposition, Ridgeline recommended pivoting to national or regional agreements focused on long term, sustainable partnerships. Ridgeline then worked to implement this strategy, working with its contacts at Regional and National health plans to negotiate agreements.
Ridgeline successfully negotiated a comprehensive, multi-year national agreement with a major national health plan. The agreement resulted in a net positive impact and ensured rate stability for multiple years. Additional national negotiations commenced and the team successfully redefined how they approached health plan discussions and partnerships.