Inside Ensemble spotlights the teams that make our partnership exceptional. This installment features our Payer Strategy team, a bench of nine contract experts, analysts, clinical partners and policy leaders working as part of Ensemble’s end-to-end revenue cycle model. The team focuses on one practical outcome: helping health systems secure the reimbursement they have rightfully earned.
In practice, the team helps clients secure stronger contract rates, get terms added to contracts to prevent RFIs or other administrative waste and navigate high-stakes situations such as out-of-network events. Across millions of claims, these experts help clients recover delayed or underpaid revenue, strengthen payer relationships and find solutions when payer performance does not meet expectations.
Why partnership around payer strategy matters
Payer relationships are one of the biggest variables in a health system’s financial performance, and one of the hardest to influence alone. Denials, downgrades, delayed adjudication, contract load errors and shifting Medicare Advantage behavior can quietly erode millions in earned revenue before the full impact is clear.
Ensemble’s Payer Strategy team changes that dynamic. Working as an extension of Ensemble’s core revenue cycle operations, the team combines contract expertise, data analytics, clinical denials insight, policy awareness and payer escalation strategy to help clients move from reactive follow-up to coordinated payer engagement. The goal is simple: in partnership with core revenue cycle operations, ensure providers are paid correctly for the care they deliver.
In the first half of 2026, Payer Strategy interventions delivered $76.3 million in confirmed payments to clients, with an additional $35 million in progress or projected through contract value and targeted recoveries. Those results came from a deliberate mix of demand letters, side-by-side payer sessions, settlements and negotiated rate improvements, each tailored to the payer behavior driving the issue.
“When there is an issue with a payer, Ensemble is all over it. If a payer changes their policy, I usually hear it from Ensemble before I hear it from any other organization.”
This kind of partnership matters because payer issues rarely stay isolated. A single policy change can affect authorization processes, clinical denials, payment timing, patient financial communication and downstream cash performance across multiple hospitals. Because Ensemble has line of sight across many health systems, the team can spot emerging payer patterns earlier, determine whether an issue is isolated or systemic and help clients respond before the impact spreads.
That broader visibility also strengthens advocacy, including collaboration with state hospital associations when payer trends or policy changes benefit from coordinated industry engagement. When Ensemble identifies the issue early, clients gain time to respond with the right data, the right stakeholders and the right escalation path.
Behind the scenes with the Payer Strategy team
Led by Stacie Sutter, Vice President of Payer Strategy, the team functions as an extension of client managed care, finance, operations and executive leadership, working in lockstep with Ensemble’s denials management and clinical teams so payer escalations and peer-to-peer conversations move as one coordinated, end-to-end effort. Payer Strategy actively supports contract renewals on behalf of clients, helping health systems navigate increasingly complex payer negotiations. The team’s work spans several high-impact areas:
- Payer contract negotiation for hospitals: Across 2025 and 2026 to date, Payer Strategy’s work has supported more than $135 million in estimated incremental client revenue over three-year terms through improved contract renewals and rate negotiations.
- Demand letter strategy: Evidence-backed demand letters have driven $63.5 million in payments received across 17 clients, addressing $339.2 million in disputed gross and net exposure.
- Side-by-side payer sessions: Direct working sessions with payers have resolved high-dollar backlogs, surfaced systemic adjudication issues and helped accelerate payments tied to impacted claims.
- Settlement support: The team supports negotiated resolution of complex Medicare Advantage, exchange and underpayment disputes, helping clients convert payer engagement efforts into measurable financial outcomes.
- CMS advocacy: In partnership with Ensemble’s Revenue Protection and Clinical Denials teams, the Payer Strategy team helps coordinate appropriate CMS complaints before issues escalate. The team also supports Department of Insurance complaints for payer issues that typically fall outside Medicare Advantage.
Because the team operates across payer strategy, contract economics, denials, policy and operational performance, it can spot patterns that may be harder to identify from one function alone. That cross-functional view is where much of the team’s added value lives.
Capabilities + focus areas at a glance
Contract + negotiation
Commercial + Medicare Advantage contract renewals
Rate benchmarking
+ market positioning
Contract language
+ protection review
Aged AR quantification
Recovery + enforcement
Demand
letters + payer
escalations
Settlement support
Side-by-side
payer working
sessions
Payer performance documentation
Policy +
innovation
Price transparency strategy
CMS complaint strategy + regulatory advocacy
Government reimbursement optimization
One recent example shows the impact: At a southwestern health system, the team helped move a payer renewal from an initial trend below a 1% annual increase to an agreement with a 7.5% Year 1 increase. The result was supported by payer demand letters, executive escalations and revenue cycle performance documentation. The agreement was expected to position reimbursement at or near the 90th percentile in the market. For the hospital, the difference was not just a better contract rate. It meant stronger reimbursement predictability and more financial capacity to support the care patients depend on.
That outcome reflects the team’s core operating model: bring the facts, quantify the issue, align the right leaders and keep pressure on resolution.
Meet Mackenzie Wallace, Director, Healthcare Policy
As payer, regulatory and legislative dynamics become more connected, Ensemble is also building a stronger policy and government affairs capability within the broader Payer Strategy function. Mackenzie Wallace, Director, Healthcare Policy, brings more than a decade of healthcare-focused public policy, advocacy and government relations experience to that work.
Before joining Ensemble, Mackenzie served as Director of Public Policy for the Alzheimer’s Association, where she advanced bipartisan healthcare legislation, worked with state agencies and helped shape policy and regulatory changes affecting Medicaid services, aging services, healthcare infrastructure, workforce training and provider-facing requirements.
Q: What drew you to healthcare policy work at Ensemble?
A: I’ve always been drawn to the place where policy decisions meet real-world implications for patients and consumers. At Ensemble, there is an opportunity to connect what is happening in legislation, regulation and public policy to what health systems need to understand and act on so they can better serve patients and provide high-quality care. This is not policy in the abstract. It is policy translated into practical implications for clients, operators and executives.
Q: What does building the policy function look like day to day?
A: A lot of the early work has been about building the right foundation: mapping Ensemble’s client-state footprint into legislative session calendars, establishing state and federal tracking tools and aligning with Legal, Compliance and other internal teams so we have clarity around ownership. From there, we have prepared materials on topics like CMS proposed rules, Medicaid work requirements, hospital price transparency, medical debt legislation and Federal IDR enforcement.
Q: What skills are most important when helping clients navigate payer strategy?
A: Our work requires both persistence and judgment. We do not escalate every issue the same way. Instead, we work with clients to determine which payer behaviors require education, which require operational follow-up and which require a more formal response. Behind the scenes, I assess the state and federal policy environment to identify emerging legislative and policy trends that could affect our clients. That work supports a more coordinated response, one that protects reimbursement while giving clients a stronger voice in payer conversations.
Q: How does policy work connect back to what Ensemble’s clients experience?
A: Every CMS rule, state statute or payer accountability issue eventually shows up somewhere in a provider’s operations. My role is to identify those issues earlier, translate technical and often political details into executive-ready guidance and route the right information to the right people. Earlier awareness enables clients to make better decisions and avoid surprises.
The value of a proactive stance
The same proactive mindset that drives payer recovery also shapes how the team approaches innovation. Payer Strategy works with internal and client teams to strengthen Epic Payer Platform adoption, align leaders around long-term compliance and payer strategy objectives and support standardized processes across authorization, payer communication and escalation.
The team also helps clients use price transparency data as a strategic asset rather than only a compliance requirement. By incorporating transparency analytics into payer benchmarking, market analysis and negotiation strategy, Ensemble helps clients identify reimbursement opportunities, reduce compliance risk and strengthen market positioning.
For clients, that proactive stance provides support many health systems might otherwise purchase from high-cost third-party consultants. With Ensemble, payer strategy expertise is built into the partnership, giving clients dedicated support around payer engagement, reimbursement strategy, regulatory awareness and escalation planning without a separate invoice for that work.
That means health systems gain more than issue resolution. They gain a connected team focused on protecting revenue, strengthening payer conversations and identifying risks before they become larger financial or operational problems.
Why health systems partner with Ensemble on payer strategy
- We align the right teams faster: Clients gain one connected team across payer strategy, denials, clinical operations, contracting and policy.
- We turn payer data into stronger leverage: Negotiations and escalations are supported by payer performance documentation, aged AR analysis, contract review and market context.
- We help clients act before policy changes disrupt revenue: Ensemble helps clients understand how CMS rules, policy changes and payer accountability mechanisms affect daily revenue cycle operations.
- We turn payer issues into action: The team does not stop at identifying the issue, instead helping clients move from insight to action with the right documentation, payer engagement and follow-through.
The bottom line
The Payer Strategy team’s work often happens behind the scenes, but the impact is clear: more timely payments, stronger payer conversations, better contract value and earlier awareness when policy or payer behavior changes.
Whether a client is preparing for a difficult renewal, addressing a systemic denial pattern, evaluating a payer policy shift or building a more proactive payer engagement strategy, Ensemble’s Payer Strategy team brings the expertise, data and persistence this work demands.
Ensemble acts on behalf of and at the direction of its clients.
