Case Study

QHR Health Client Success Story: Improving Payer Yield

Challenge

A small hospital in the Southwest was facing significant financial challenges that threatened the ongoing viability of the organization.

QHR Health Solutions

QHR Health conducted a thorough analysis of the hospital’s health plan contracts. The analysis revealed the commercial contract yield was less than 15 percent; for every dollar in net expected reimbursement from the contract, the hospital collected 15 cents. The Medicare Advantage yield was less than 20 percent.

Results

QHR Health’s managed care experts met with every payer to review current contract performance. As the direct result of QHR’s focus on improving the performance of current contracts, payer yield – that is, actual dollars collected by the hospital – jumped. Better contract performance improved the commercial yield from 15 to 65 percent and the Medicare Advantage yield from 20 to 54 percent. The hospital realized nearly $4 million in revenues due to improved contract performance.

QHR Health also educated and trained the hospital’s staff to identify and remedy areas where payer contracts are being administered inappropriately.

Client Quote

“Without QHR Health’s expertise in managed care contracting and payer relationships, I fear our hospital would have been forced to close its doors. The $4 million in additional revenue was critical to our financial turnaround.”
C-Level Executive
Small Southwest Hospital

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