Case Study

QHR Health Client Success Story: Payer Contract Negotiations and Administration to Improve Yield

Challenge

A 100-bed hospital in the Southeast sought to improve its financial performance.

QHR Health Solutions

The QHR Health Managed Care Team conducted a thorough analysis to measure contract performance for all of the hospital’s payers, and then used the analysis to lead payer negotiations on behalf of the hospital. In addition to payer contract negotiations, QHR Health is monitoring ongoing performance through contract administration in order to steadily improve revenue over the long-term.

Results

The QHR Health payer contract negotiations yielded $1 million in new revenue across multiple payers. Then, QHR Health continued to measure the yield versus the contracted amount to identify additional opportunities to improve revenue. As shown below, the variance between actual payments (orange) and the negotiated rates (gray-blue) represents an even greater opportunity to improve the contract yield. Combining the negotiations with these payers with ongoing contract administration offers the potential of approximately $1.5 million in additional revenue.

Client Quote

“The expertise and professionalism the QHR Health Managed Care Team brings to payer contract performance and negotiations are unparalleled. I wouldn’t want to go into a payer renegotiation without QHR Health.”
C-Level Executive
Large Southeast Hospital

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