Guiding healthcare providers to optimal financial performance

Healthcare providers are increasingly confronted by a key strategic question—"do we need to transition various payer segments from our traditional fee-for-service business to a value-based care and reimbursement model (and, if so, how quickly)?”.

We draw upon our expertise and industry experience to guide providers in determining if, when, and how to approach this business model evolution. Our team will assess your market landscape, current capabilities and strategic priorities to determine the best long-term enterprise strategy for your organization.

As healthcare providers face rapid cost growth and increased pressure from price transparency, the need for a comprehensive payer strategy has never been greater.

Informed by national insights, we evaluate market and payer dynamics across various ‘purchaser segments’ including Employer-Sponsored, Individual, Medicare and Medicaid. We then develop the right enterprise payer strategy, segment-level payer strategies and approaches for each major health plan in your market with the goal of optimizing your market position and organization’s revenues.

Pricing strategy has taken on a new level of importance in the age of federally mandated price transparency. A successful pricing strategy is built on your value proposition and optimizes your revenues over the short and long term by determining the right price for the services your organization delivers.

We help you understand your price position in the market and the ‘shop-ability’ of your services. Informed by your enterprise strategy, we can then develop the right pricing strategy to support your organization’s long term success.

Ridgeline Health Group is here to help whether you are looking for support on a major negotiation or to augment your managed care team on an interim basis.

Informed by market analysis, out-of-network scenario planning and contract modeling, our team has deep experience in developing effective negotiation strategies and successfully completing negotiations with all types of health plans across the country.

Growth is a challenge for many providers. Health systems have the opportunity to drive organic growth by partnering with payers to launch innovative insurance products anchored by their provider networks.

Ridgeline has extensive experience understanding the expected market of insurance product strategies, finding the right health plan partner and successfully launching the partnership. Further, we have helped organizations develop center of excellence programs for employers which have driven significant increases in commercial market share.

Ridgeline can enhance the performance of your managed care function. Drawing upon best-in-class processes, tools and frameworks, we are able to efficiently assess the performance of your organization’s managed care function and identify and execute on priority opportunities to elevate performance.

During times of transition, we can support your organization with our bench of experienced professionals in a variety of roles.

Amidst continued pressure on fee-for-service rates, the healthcare industry is continuing to expand value-based care and contracting efforts. As healthcare providers approach this transition, the first step is understanding your organization’s level of readiness to assume risk for episodes or on a per capita basis for various populations by assessing capabilities and current strategic plans.

Informed by these capabilities, we then develop the right multi-year value-based strategy for your organization, appropriate negotiation guardrails and often provide support to value-based negotiations. Further, we often leverage our deep experience in designing and optimizing provider networks to help accelerate performance in value-based arrangements.