Our philosophy centers on the assumption that each market is unique, requiring individualized strategy development to successfully address goals. It is imperative that your organization be prepared, even before challenges and opportunities arise, by having experience and practical knowledge readily available for guidance through the evolving managed care maze.
Though our consulting services are continually adapting as new managed care issues present themselves, some of our more frequently utilized services currently include:
Managed Care Strategy Development
KBH analyzes current local and regional market dynamics, reviews existing managed care contracts, forecasts anticipated market trends and develops contracting strategies specific to each managed care payor and/or network in your local market.
Charge Master & Fixed Rate Pricing Strategy
The growing popularity of consumer-driven initiatives are increasing costs to consumers, leading them to “shop” for healthcare services based on quality and cost. Government initiatives are also calling for more transparency in provider pricing.
KBH will work with your staff to develop defensible pricing and reimbursement strategies that are both market competitive and fiscally responsible.
Delegated or Outsourced Managed Care Functions
We provide the additional expertise and resources necessary for community providers to streamline managed care issues such as contract negotiations and claims denial management and offer outsourced support under both short and long-term arrangements.
Expertise at a fraction of the cost of a dedicated FTE
Streamlined communication between leadership & staff
Supported decision making
Ongoing resource for flexible & tailored consulting
Centralized repository for information & data
Improved focus on core activities
Local & national market intelligence
Selection & Training of Managed Care Director & Staff
With administrative turnover being a reality, let KBH assist your company in locating and training the right person for the job.
Expert Witnesses for Major Claims Disputes
KBH has served as an expert witness in several major legal claims disputes, providing technical support to legal counsel on behalf of providers. Utilizing our extensive data resources in combination with our managed care experience, KBH assists in the dispute resolution process through detailed customized reports and depositions when necessary.
PPO, PHO, Branded Product Development
Our role as facilitator covers every aspect of cooperative development from strategic feasibility to organizational and operational issues. While we are not able to provide legal advice, we work closely with your legal counsel to arrive at the proper structures which can meet the practical needs of the local provider community.