Hansei Solutions offers managed care contracting and contract negotiations to help behavioral healthcare providers secure relationships with payors, ensure the best deals for their practice, and improve patient costs and services.
Managed care contracts are key in ensuring effective behavioral healthcare delivery while staying favorable to your practice’s bottom line. These contracts significantly impact the daily decision-making of behavioral healthcare providers by determining the services they can offer patients. The influence of negotiations extends beyond mere payor-provider relationships, shaping the availability, recipients, and costs of various healthcare services.
Hansei Solutions understands that behavioral healthcare providers can become overwhelmed or lack the resources or time to negotiate competitive terms with health plans like Medicare and Medicaid. Our services act as a bridge, utilizing our expertise and experience to facilitate mutually beneficial and profitable agreements between payors and providers.
Improved Capacity: Our team enhances your ability to analyze and monitor your contracts effectively, so you can still manage and understand what’s happening behind the scenes.
Increased Revenue: We’ll help you boost your reimbursement rates by securing more competitive contract agreements so you can focus on patient satisfaction.
Data-Backed Negotiations & Renegotiations:Our extensive database of market rates and established relationships with payors and health plans can help negotiate and renegotiate terms backed by solid data and reputation.
Effortless Communication:Our extensive connections and contacts ensure quick and efficient results without unnecessary delays or complications for your practice.
Before Hansei seeks out contracts and negotiations, we thoroughly assess your organization and the current market landscape. We’ll guide behavioral healthcare providers through this initial process, examining key areas and addressing essential questions:
We want to know how your organization and services are perceived in the market and by the general public. We’ll look at your strengths, recent investments or enhancements to services, and any awards or accolades. By reviewing other practices and providers, we can help you stay updated on changes made by competitors.
Hansei will analyze your practice’s financial performance with different payors, including payments and profit margins. As we compare rate structures, rates, and performance, we can create a game plan based on internal and external benchmarks. This also helps us recognize significant service changes and objectively evaluate your goals.
We’ll review current contracts and analyze rate changes, trends, and adjustments from payor operations. This gives us insight into any increases in denials, reduced authorizations, or payment rate modifications. We can also monitor and scrutinize contract language for opportunities to enhance terms and lower costs.
Finally, we’ll evaluate the financial performance of each payer in and out of your network. This allows us to identify changes or trends exhibited by payers, such as premium increases, profitability, and membership variations.
Once Hansei understands your needs and goals, we’ll work with you to strategize and choose or renegotiate contracts that will improve your bottom line.
Pricing & Rate Strategy: We begin by evaluating payment rates from each payer to identify the highest and lowest payers. This analysis enables us to determine the necessary rate increases required to achieve parity within the managed care contracts, considering market-competitive rates if available. We then establish minimum and target rate increases, defining acceptable desired rates and identifying which payer contracts should be negotiated for better terms while determining contracts that can remain unchanged.
Product Strategy: Hansei will help define pricing targets and essential requirements (e.g., pricing, contract language) for different products and plans like HMO, PPO, Medicare Advantage, Medicaid, and others.
Time Frames: Hansei Solutions emphasizes the importance of prioritizing payer contracts based on net payment, payment rates, market share, and profitability. We work closely with behavioral healthcare organizations to determine the optimal timing for initiating negotiations with each payer, ensuring that opportunities are maximized.
Negotiation Strategy: We’ll strengthen your negotiating with insurance companies and payors by evaluating your strengths, quality of value-based care, non-competitive services, and practice profitability. We’ll also gather any operational changes or payment issues encountered with the payer for more leverage.
Once we have agreed on a plan, we’ll start negotiating or renegotiating agreements with payors. This includes requesting new contracts, escalating issues when denials occur, and presenting alternative proposals. We will inform you at each step of the negotiation process and ask for your input and signature on new contract terms once the payor approves them. Our revenue cycle management focus will ensure that these contracts support all aspects of your practice and use all of our resources to help, including our own law firm, to escalate denied and underpaid claims.
Hansei understands the importance of competitive rates and favorable terms in driving revenue growth for behavioral healthcare providers. By ensuring that your payor contracts are structured to offer better rates and expedite reimbursement for your services, we empower independent providers to expand their operations. This enables them to tap into new markets, offer specialized services, and attract a larger patient base, setting the stage for long-term success and sustainable growth.
Ready to focus on providing healthcare? Let us lighten your load.
We’re here to address your pain points and create growth opportunities for your organization. We’re passionate about what we do, and it shows in every interaction. Learn what makes us tick and schedule a demo today.