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.
negotiations supported
contracts managed
with payers
vs. industry average
SOLUTION SNAPSHOT
We deploy a proven offensive strategy to improve payer performance.
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
CEO, Tower Health
CLIENT SNAPSHOT
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%.
