Hospitals and Physicians

As a hospital or physician group, lacking reliable intelligence on contract rates can hurt you in your efforts to negotiate contracts, set pricing, and evaluate new models of care.

Have you ever been at the negotiating table with an insurer and they tell you that the contract rates you are asking for are unreasonable? Have they told you that your rates are on par or better than your peers in the local market? Have they told you that you need to accept reduced rates or risk the possibility of being forced out of network?

Having served hundreds of provider clients, we hear these stories again and again. Providers can feel frustration when big health insurers claim to have comparative data and the providers do not. They obviously know their current rates with your competition — but they also access Coordination of Benefits information to know what other insurance companies reimburse your hospital or physician group. Providers do not have access to the same level of contract rate data as insurers and they feel helpless when they cannot validate or refute what insurers are telling them.

We provide hospitals and physician groups with patient claims data that can be used as concrete evidence in support of their argument at the negotiating table.

Become More Competitive

Current, relevant, and precise contract rate intelligence about your competition will let you discern the difference between truth and exaggeration. It gives you the ability to know how much room you have to negotiate, and how health insurers are treating you compared to your competition. This type of information can be used in analyses, discussions, and negotiations with health insurers, employers, and other parties.

No more guessing how your payment rates from commercial insurers compare to your competitors, or whether you’re being paid at, above, or below market.

No more guessing whether your contracts are fair, and whether you need to push for rate increases or take a different approach.

FlexPoint Health gives you what you need to be able to set pricing and negotiate with confidence.

The Granularity You Need

Traditionally, hospitals and physician groups have invested in contract rate data that is calculated based on average payment rates within a market — and contract rate data that uses non-current blended public data or all-payor claims databases. Some providers make the critical mistake of relying on data provided in cost estimator tools made available by big insurance companies to their insured members. These cost estimator tools share averaged pricing for only a limited number of services and fail to provide current, specific and meaningful rate information for specific providers in a local market.  These types of data sources are only minimally useful when you are in negotiations or evaluating a new pricing strategy.

To gain better clarity, we believe that providers should have access to contract rate data that is at a level of specificity that matches the way contract rate sheets are written. Your organization deserves to have contract rate data at a level of specificity that matches the way you and your competition are reimbursed for services. Providers need to know exactly what each insurer is paying its major competitors in the local market. With a current and specific level of contract rate data, providers can eliminate guessing, better challenge the insurers and exert more control in contract negotiations.  And with this level of data, providers can–and must–level the playing field once and for all.

We are able to provide data for the following types of physician groups:

  • Emergency medicine
  • Hospital medicine
  • Anesthesiology
  • Radiology
  • Neonatology
  • Primary care & other specialty groups

We are able to deliver contract rate specificity for the hospital services outlined in the table below.

SERVICE PRECISION OF CONTRACT RATE INTELLIGENCE
INPATIENT
Medical/Surgical DRG base rate; Per diem; % of charges
Carevouts (e.g. Maternity, Bariatric, Ortho, Psych, etc.) DRG base rate; Per diem; % of charges
Outliers % of charges & stop loss data
Implants % of charges & pass through data
OUTPATIENT
CT Fee schedule; % of charges; 3M – EAPG base rate if applicable
MRI Fee schedule; % of charges; 3M – EAPG base rate if applicable
Ambulatory sugery levels Fee schedule; % of charges; 3M – EAPG base rate if applicable
Emergency room levels Fee schedule; % of charges; 3M – EAPG base rate if applicable
Other outpatient Fee schedule; % of charges; 3M – EAPG base rate if applicable
Implants % of charges & pass through data