Guidehouse has one of the largest and most experienced teams of managed care and pricing experts in the industry. We work with many of the nation’s largest payers and providers, helping them to:
- Develop focused strategies and best practices;
- Benchmark reimbursement rates, quality, and access;
- Design and negotiate contracts; and
- Develop new products and services that improve access, health, and affordability.
We have worked in more than 80 markets nationally and have a robust database of comparative cost, reimbursement, efficiency and quality benchmark data.
We offer a range of core services for managed care pricing and negotiations:
- We assess hospital and physician market position based on key variables such as unique services offered, quality of service, outcomes, competition, payer mix, and other factors.
- We benchmark hospital and physician reimbursement prices, rates and costs (at diagnostic-related group (DRG) and current procedural terminology (CPT) billing levels), utilizing Guidehouse’s databases of market data. This allows us to objectively analyze “price” vs. cost vs. quality vs. “value” in a way that patients, purchasers and payers can understand.
- We offer an array of various value-based contracting arrangements that achieve different unit reimbursement, cost, volume, and mix scenarios, and overall margin targets for payer strategy, health systems, and physician groups.
Latest From Managed Care, Negotiations, Pricing, & Payment Innovations
November 8, 2021 Infographic2021 Risk-Based Healthcare Market TrendsA Guidehouse analysis of an HFMA provider executive survey points to health system trends in risk-based payment models, payer/provider partnerships, and budget outlooks.
June 3, 2021Now is the Time for Payvider Adoption & GrowthThe rules of the game for delivering high-quality, cost-effective, consumer-centric care are changing, and payers and providers that don’t adapt their business models will be left behind.
July 9, 2020 VideoAnswered: Your Pressing Questions About the Federal Price Transparency Rule
September 5, 2019 InsightsFive Lessons on Launching a Provider-Sponsored Health PlanKai Tsai and James Smith, HFMA
August 14, 2019 InsightsFinancial Impacts of Medicare Expansion Proposals on Hospitals Appear DauntingBy Jeff Leibach, Jeff Goldsmith, and Kurt Eicher for HFMA
June 20, 2019 InsightsProviders Plan to Up Spending on Health IT to Support More RiskRich Bajner and Kai Tsai, HIT Infrastructure
June 19, 2019 InsightsHealth Systems Eye Commercial Payers for More Downside RiskRich Bajner, Modern Healthcare