public health consulting firm

Public Sector Health

Public Sector Health

public health strategy consulting public health strategy consulting

Strategy & Innovation

Managed Care, Negotiations, Pricing, & Payment Innovations

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.
Download Strategic Alternatives: Pathways to Approach Hospital Price Transparency & Improved Revenues, Volumes, & Margins

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