Payer Negotiations Expert
We negotiate higher
payer rates for hospitals and health systems
Negotiating from a position of strength.
Client Success Spotlight:
Bon Secours and Anthem Blue Cross Blue Shield reach agreement following tense negotiations
The new multi-year contract means all Anthem Medicare Advantage and Medicaid health plan members will have continued in-network coverage at Bon Secours until 2028.
Trusted by Leading Health Systems across the Country.
We’ve worked with provider clients including:
$28B Multi-State Hospital System
$10B Multi-State Hospital System
Large Statewide Health Systems
Dominate Local Hospital Systems
Regional Health Systems
National Physician Groups
Statewide Behavior Health Groups
Critical Rehab Hospitals
National Imaging Groups and more!
To negotiate with the largest payers including:
We achieve real results for our clients. Since 2022,
$20B
In Closed Contracts with Payers
$3B
In Payment Increases
$1B
Revenue Over Target in Payer Contracts
We can do the same for you and your health system.
With over 30 years of executive payer experience, we’ve witnessed first-hand how providers win. Our approach:
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Understand the leverage you have as a provider
Our favorite term at Ellsworth Consulting is “Leveraged Negotiations.” We understand what leverage gives our clients the advantage and how to effectively use it to increase your payer reimbursements.
Patients, especially seniors, are loyal to doctors, not the insurance company. Providers have more leverage than you realize.
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Start 12 months in advance
Initiate the payer contract negotiation process well in advance of the contract end date to allow ample time to conduct thorough research, identify key objectives, and lay the groundwork for a successful payer negotiation strategy.
It takes time to obtain and analyze data, develop your strategy, and engage payers early. This will ultimately enhance your ability to secure favorable terms and outcomes.
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Drive decisions with data and analytics
We ensure that your negotiation stance is backed by a foundation of accurate data and analytics. Payers expect Providers to have Price Transparency Data at the negotiating table. Providers must know where they stand relative to other providers.
By grounding your position in objective data, we’ll bolster credibility and demonstrate a commitment to transparency and informed decision-making.
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Align your contracts to support strategic objectives
Contract language can be more important than rate increases.
Down-coding, claim denials, and bad debt significantly impact financial performance by reducing revenue yields, highlighting the importance of addressing these issues during payer contract negotiations to ensure fair reimbursement and optimize profitability.
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Escalate negotiations
Escalating negotiations to executive payer leadership is critical to successful negotiations. Ellsworth Consulting will help you pinpoint the real decision makers and how to engage them.
Providers typically start contract negotiations with the contracting staff, who tend to be inflexible and unreasonable during negotiations. The goal is to escalate negotiations quickly to payer executive level leadership.
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Align with leadership
Secure executive leadership buy-in up front. Payer negotiations can become intense, so it is vital to ensure that provider executive leadership are firmly aligned to navigate through potential challenges.
Ellsworth Consulting will help you provide regular leadership updates, manage expectations around termination, and anticipate payer moves.
Our extensive knowledge prepares providers to negotiate from a position of strength. Take it from our clients:
“Ellsworth Consulting played a strategic role in helping USACS successfully contract with key national payers in states critical to our enterprise.”
— James Watson, CFO,
USACS
“Ellsworth Consulting quickly got up to speed on our challenges and developed a strategy. They utilized their experience to anticipate payor negotiation tactics. Their commitment, experience and willingness to dive right in were evident from the outset.”
— Michael Pazzo, CLO, RSFH
“Ellsworth Consulting's impressive healthcare knowledge and project management skills were critical to us achieving success in payer negotiations. Their expertise at effectively communicating across both internal and external customers was invaluable throughout the engagement.”
— Chuck Faller, VP Managed
Care, Rochester Regional Health
Ellsworth Consulting works exclusively with providers.
What makes us different? Other consulting firms work with both payers and providers, and are conflicted during intense negotiations. Ellsworth Consulting works exclusively with providers , and specializes in securing higher reimbursements from payers.
With over 30 years of executive experience, we have witnessed first-hand how providers win and lose at the negotiating table, and show you how to negotiate from a position of strength. We get results for our clients AND do it in a way that ultimately leads to better payer relationships.
