H E A L T H    P L A N    S E R V I C E S
Managed Care Financial Policy & Reimbursement Analysis
 

Reimbursement has become increasingly complex as managed care organizations have experimented with different models in attempts to manage costs and share risk. At Presscott Associates, we assist our payor and provider clients examine the amount of risk they are able to share and manage, respectively. We provide our clients with the tools they need and share the experience that we have gained during the last three decades to help them make informed decisions when developing their approach to negotiating and agreeing upon various reimbursement methodologies.

Presscott Associates assists healthcare organizations in evaluating Pay-for-Performance, risk-sharing arrangements and capitation fee structures. As managed care organizations look to encourage quality, cost-efficient outcomes and share the risk of insuring their members to providers, new opportunities are being made available to hospitals, physician groups, and integrated delivery systems to participate in innovative reimbursement models. We support our clients with the information and expertise needed to assess and negotiate favorable arrangements, assess the up-side and down-side risks, and avoid the administrative pitfalls that can often exist. Furthermore, to help health plans maintain target Medical Expense Ratios, we provide detailed analyses of all types of reimbursement arrangements. We also negotiate reimbursement arrangements on our clients' behalf. Experience allows us to ascertain what providers will and will not accept, so that negotiations move along efficiently to a favorable conclusion.

For our payor clients, our current knowledge of marketplace expectations and our sophisticated analytical abilities enable us to advise payors on rate negotiations and provider network development or enhancement. We assist payors in structuring innovative reimbursement models and setting up fee structures and risk-sharing arrangements. In particular, we can support:

  • Medical Expense Ratio (MER) analyses
  • Disease State Management implementation analyses
  • Pay-for-Performance models
  • Financial Modeling

Even if you're on the right track, you'll get run over if you just sit there.
-- Will Rogers --

 
    21A Arts Center Court  |  Avon CT 06001  |  860.677.7888
home  |  contact us
© 2008 Presscott Associates LTD
Webmaster