Ensemble Health Partners

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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 ​
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Unique payer
contracts managed​
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In settled disputes
with payers​
$ 0 B+
Higher rate increases for clients
​ vs. industry average​
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"Ensemble is not responsible for managed care contracting, but they help us network with other organizations. They know what payers are doing in other markets across the United States, so they can anticipate the next moves in their contracts, and that is extremely helpful."
Health System CEO/President, May 2025, KLAS Research Interview
"Ensemble is not responsible for managed care contracting, but they help us network with other organizations. They know what payers are doing in other markets across the United States, so they can anticipate the next moves in their contracts, and that is extremely helpful."
Health System CEO/President, May 2025, KLAS Research Interview
"The development of a managed care support operation within Ensemble over the last couple of years has been great for us too; the operation is not only for analytics but also for advice and help with contract negotiations and litigation issues against managed care payers and the like."
Health System CFO, March 2025 KLAS Research Interview
“We knew we needed a strong partner able to go toe to toe with the insurance companies and make sure we get the payment we deserve for our services — and we knew we had one with Ensemble.”
Marty Bonick, President + CEO, Ardent Health Services​​​
"Ensemble helped us well with a 340B program or an issue that we had in trying to recoup funds from the health plans. The firm has helped us with our contracting and has given us contracting tips on how to best go after certain health plans. They have been proactive in those areas as well, so we have gotten good information there."
Health System CFO, March 2025 KLAS Research Interview
"Ensemble has expanded into more payer strategy and payer relations, and I’m ecstatic about that. They have added a team, and that is very helpful for our payer-relations team."
CFO, March 2025 KLAS Research Interview
"If there is a hot topic out there, if there is advocacy or if something is going on with payers that we need to know about, we get ready-made, proactive documentation from Ensemble about how things are going to impact us and what we need to do for those things not to impact us."
CFO, March 2025 KLAS Research Interview
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

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.

See Full Results
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%. 

Resources​

Why Hospitals Are Doubling Down on ‘Payer Scorecards’

As hospitals face increasing pressures, a growing number of leaders are turning to an old business truth: What gets measured, gets managed.

6 Terms to Close Payer Contract Loopholes 

Revise contracts to include language that clearly defines dispute resolution requirements, non-compliance penalties and enforcement mechanisms

Payer Strategy Playbook: Reducing Friction to Restore Focus 

Learn 8 key strategies to reduce friction between payers and providers in order to bring patient care back into focus.

4 Strategies to Level the Playing Field with Payers 

Ensemble's VP of Payer Strategy shares four innovative payer strategies to negotiate better contract rates and establish market leverage.

3 Proactive Steps to Counteract Payer Denials and Delays

Receiving accurate, timely reimbursement and reducing unnecessary administrative cost imposed by payers requires a proactive strategy.

Providers Should Push Back Against Direct EMR Access for Payers 

Lessons learned from providers who have granted direct EMR access to payers​.

Tips for Providers Thinking of Going Out of Network

Understanding the implications and implementing a well-thought-out strategy is crucial to providers considering going out of network.

3 Tips to Successfully Negotiate Your Next Payer Contract

Providers must leverage what's in their payer contract, comparative data and price transparency rules to level the playing field with payers.

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