Network Contracting & Evaluation

Negotiation Support Solutions

Reden & Anders translates the competitive data contained in ReimbursementAnalysis into a powerful message for a payer—and helps them bring more to the negotiating table. This critical information can help keep unit cost trends in check as contracts are renewed. Furthermore, we can work with your network management team to develop a contract structure that best meets your health plan’s goals and minimizes uncertainty and risk in provider reimbursement.

Reden & Anders can provide guidance and alternatives in developing a contract structure to meet the payers’ objectives, such as:

  • Minimizing exposure to unexpected chargemaster increases implemented by the hospital
  • Providing the proper incentives to perform care in the most appropriate settings
  • Holding providers accountable for the quality of care provided (e.g. pay-for-performance)
  • Helping administer contracts in the payer’s payment system without inefficient manual intervention
  • Avoiding unexpected increases in reimbursement levels due to shifts in the mix of services provided by a facility

Reden and Anders can help you assess your geographic coverage (access) and evaluate the cost to redirect business and provide disruption analysis for your members. In addition, we can assist you in discussions with providers regarding ReimbursementAnalysis results and reconciliation of results to a provider’s position.  This has proven to be very valuable and has resulted in providers offering significant additional data to negotiations.