Ensemble Health Partners

SUCCESS STORIES

Level the playing field with payers.​

Leverage the scale of the third-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 ​
0 +
Unique payer
contracts managed​
0 K+
In settled disputes
with payers​
$ 0 B+
Higher rate increases for clients
​ vs. industry average​
0 x

“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​​​

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​
“[Ensemble is] aggressive with their payers, consistently investing in new technologies and scaling in areas in which it is critical to actually win more revenue for the hospitals they serve.”

CEO, Tower Health​

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 United Healthcare 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​

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.

Ready to supercharge your rev cycle?

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