“I generally give Triage projects that I want done right. If there’s something that I need done in a certain way so that I can use it for a negotiation or a settlement, or if I have questions about how it’s been processed or paid, then I recommend that Triage does it…in fact, I generally insist that Triage does it.”
– Gaynor Rabin, Vice President of Managed Care
CLIENT
Daughters of Charity
OBJECTIVE
Assistance in complex analysis for contract negotiations and special projects
CHALLENGE
Providers know the importance of credible and compelling data when it comes time for contract negotiations. Negotiations happen fast, and the data is needed even faster. Analyses need to be accurate because there is no second chance. The Daughters of Charity were in need of substantial analytical support for its upcoming round of negotiations with one of the largest health plans in the country. The data needed to stand up to intense scrutiny, and there was no time for the health system to assemble internal resources to do the work.
SOLUTION
When Vice President of Managed Care for Daughters of Charity, Gaynor Rabin, came to Triage to ask for assistance with the upcoming negotiation, the Triage team (consisting of a Principal, Manager, and three Associates) answered the call. By comparing the health plan’s reimbursement patterns for the past year with market trends, Triage identified opportunities to re-negotiate specific rates in the contract which exhibited below-market reimbursement. Additionally, Triage compiled an analysis showing that the health plan routinely paid claims beyond the state-mandated timeframe.
RESULTS
Gaynor was able to go the table with the health plan with data that she knew she could trust. Triage knew where to look to find the evidence she wanted so she could get the rates that she needed. She was able to expound hard empirical facts to the health plan, and the negotiations culminated in resounding success.
“What I appreciate about Triage the most is that their reports are consistent. If I ask Triage to do something I know that every single solitary line of an agreement will get read. It will get compared against everything they can possibly compare it to. They are very thorough and analytical…and for me, that’s critical. If I have a project that I want done right the first time, I just give it to Triage.”
WHY TRIAGE?
Triage prides itself on always being available to key hospital staff for support at all times. One of the three objectives which drive each and every Triage engagement is to arm healthcare providers with best practice language to assist them with future contract negotiations. Providers often ask “How much do you charge for this additional service?” Our answer is easy: nothing! Our providers benefit from our wealth of industry experience. Whether our clients’ needs are to accurately address optimal rate structures, critical state legislation, workers’ compensation, CMS updates, or cutting-edge technology which may affect reimbursement, Triage is there.
