The managed care team at an academic medical center (AMC) in the northeast was preparing for negotiations with a payer partner. The challenge was they first needed to better understand the competitive landscape with insights into other health systems to figure out where they had the best opportunity to secure more favorable rates. Unfortunately, they were challenged with a lack of competitive rate insights outside of their health system, leaving them to rely on historical negotiation tactics and insights from prior contracts. This limited their ability to negotiate improved rates, particularly for specific service lines with the best potential for competitive pricing.

The team evaluated various solutions and ultimately chose Clarify Rates for its comprehensive coverage and high-quality industry-leading data set. Using Clarify Rates, the team conducted a thorough comparison of their rates against local competitors, gaining clear, data-driven insights to bolster their negotiation tactics. The tailored insights, covering code types, service line analyses, and health system comparisons, quickly provided the market data needed for the team to confidently pursue more favorable rates.

With Clarify Rates, the team uncovered disparities in reimbursement rates across various service lines compared to neighboring health systems. Outpatient cardiology procedures stood out as the service line with the highest potential for rate improvement. By suggesting a modest 2% rate increase for these procedures with their payer partner, the AMC anticipated a remarkable opportunity to boost marginal revenue by $2.1 million immediately.

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