SUCCESS STORIES
Level the playing field with payers.
Leverage the scale of the second-largest health system in the U.S. to make meaningful traction with payers.
We help providers alleviate friction with payers.
We empower client managed care departments with the data, scale and approach needed to successfully resolve payer performance issues and negotiate equitable contracts.
payer-provider contract
negotiations supported
negotiations supported
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+
unique payer
contracts managed
contracts managed
k+
in settled disputes
with payers
with payers
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B+
higher rate increases for
clients vs. industry average
clients vs. industry average
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ebook
Payer trendscape: 3 trends to track
Payers are reshaping hospital reimbursement at the expense of compliance + cash flow. We dig into the data + offer tips to boost performance.
SOLUTION SNAPSHOT
We deploy a proven offensive strategy to improve payer performance.
We go beyond day-to-day defense of high-performing revenue cycle operations to deliver an aggressive offensive strategy that positions our clients to withstand headwinds, compete with scale and fuel future growth. Here’s how:
Payer scorecard
We provide in-depth and ad-hoc performance analysis, peer comparisons and anomaly detection to identify large and small issues for resolution
Strategy support
With decades of experience going toe to toe with payers, we know what works. We provide successful strategies for renegotiations, terminations and settlements.
Issue resolution at scale
We’ve developed standardized issue escalation processes with all major payers and work on behalf of all our clients for expedited resolution
OUR RESULTS
Large health system achieves 20% contract rate increase with Ensemble’s payer strategy support.
Facing a multi-year battle with a major payer over tens of millions of dollars in unpaid claims, a large multi-state health system leveraged Ensemble’s scale for a more aggressive approach to successfully terminate the problematic contracts, resolve $130 million in outstanding AR and renegotiate a 20% increase in contract rates.
Here’s how we helped:
- Planned and executed an out-of-network strategy, including orchestrating a patient ombudsman program and PR campaign to educate the community on care access and plan options
- Provided contract language to protect against future AR resolution or payer performance issues
- Led the dispute resolution process to resolve outstanding AR
CLIENT SNAPSHOT
Benefis secures material wins with payers in first 90 days.
Benefis came to Ensemble with a clear mandate: Stabilize payer performance quickly, unlock stalled negotiations and reduce administrative friction that was driving denials and cash delays. Within 90 days, collaborative efforts by Ensemble’s payer strategy support strengthened Medicare Advantage (MA) contract terms, including raising the letter of agreement (LOA) basis to 105% of CMS.
We also increased payer transparency by establishing semiannual claims reviews, improved annual net revenue by more than $567k through contract renewal and furthered claim recovery with demand letters covering $1.6M+ and Epic protections totaling $1.25M.
CLIENT SNAPSHOT
Health system boosts MA revenue 5% by closing compliance gaps.
To support Medicare Advantage (MA) payer compliance with the CMS Two-Midnight Rule and address differences in performance between traditional Medicare and MA, a large health system collaborated with Ensemble to enhance utilization management processes, including the introduction of peer-to-peer reviews. Over a period of seven months, this approach resulted in an 11.5% increase in inpatient MA admission ratios, stable initial denial rates and a 5% rise in revenue per account.
CLIENT SNAPSHOT
20-hospital system reduces authorization turnaround from 3 days to 1 hour.
Ensemble’s payer strategy team collaborated with a large hospital system’s authorization team and UnitedHealthcare to create an automated documentation strategy that leverages Epic’s electronic medical prior authorization (eMPA) capability to accelerate the authorization process and decrease authorization-related denials.
Within 45 days of implementation, 88% of eMPA requests and decisions were completed with zero manual intervention, decreasing labor costs and reducing authorization completion time by 33%.
