Managed Care

JTaylor’s Managed Care team has vast knowledge and experience in managed care strategy, revenue analysis, contract review and negotiation, and commercial managed care payment models for hospital inpatient/outpatient services, physician and clinic services, ambulatory surgical care centers, behavioral health services, and post-acute care.

Managed care reimbursement has a significant impact on any healthcare provider’s financial health. Administrators and financial executives need analysis and insight to enable them to optimize their contracts. JTaylor can help navigate this critical area for providers who have experienced personnel changes in finance or managed care payer contracting leadership, or for any provider needing outside expertise to supplement in-house resources. Key areas of focus for our Managed Care team include the following:

  • Pricing Intelligence
    Engage JTaylor to analyze your payer contracts, compare contracted rates to the local market, identify anomalies and revenue opportunities in your payer contracts, and assist you with data visualization techniques to optimize your financial performance. We apply healthcare analytics to develop a contracting plan using real historical data so you can quantify the impact of contractual changes.
  • Contract Negotiation
    Once you have determined your contracting strategy, JTaylor can assist you in negotiating with commercial payers to achieve the desired contract terms. Our team has extensive experience in this type of communication.

JTaylor’s experienced team can utilize a provider’s historical data to identify opportunities for revenue enhancement. Examples of potential analyses include the following:

  • Benchmarking contracted rates for health systems with multiple sites of service (hospital, clinic, ASC) to market rates;
  • Performing payment analysis to identify underpayments, overpayments, or denials;
  • Developing models to optimize charge-based reimbursement while minimizing the aggregate impact on the chargemaster;
  • Developing scenario analyses to assess the impact of shifting from a hospital outpatient department to bill as free-standing clinic; and
  • Developing customized reports to visualize data, detect trends and identify revenue enhancement opportunities.

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