Capability

Managed Care Contract Negotiations

Reimbursement that reflects the value you deliver.

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Managed-care contract negotiation sets the rates and terms between healthcare providers and health plans across Medicare Advantage, commercial HMO/PPO and Medicaid. Carafelli Healthcare brings first-hand payer and hospital experience to the table so you negotiate from data and leverage — not hope.

Too many providers accept rates that were set years ago. The plans on the other side of the table have full contracting teams, market data and a clear strategy. Carafelli Healthcare levels that playing field — and often leads the negotiation for you.

How Carafelli Healthcare helps

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Rate analysis & benchmarkingCurrent reimbursement by line of business, compared to Medicare and market benchmarks.
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Negotiation strategyTargets, acceptable ranges and a defined walk-away, modeled across the full term.
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Contract language reviewEscalators, evergreen renewals, termination, timely filing and dispute terms.
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Direct negotiationChristine and her team lead the negotiations directly with managed care organizations and health plans.
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Multi-year planningRate and escalator strategy so today's deal still works in years to come.
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Payer-mix insightWhere your leverage actually sits across Medicare Advantage, commercial and Medicaid.

Common questions

Which lines of business do you negotiate?

Medicare fee-for-service, Medicare Advantage, commercial HMO/PPO, and Medicaid and managed Medicaid — often across several payers at once.

Can you negotiate on our behalf?

Yes. Christine and her team will lead the negotiations directly with managed care organizations and health plans.

Related capabilities

Health Plan Relationship DevelopmentLearn more →Provider Network DevelopmentLearn more →Revenue Analytics & OptimizationLearn more →

Let’s talk about Managed Care Contract Negotiations.

A short conversation with Christine is the fastest way to see where the opportunity is.

christine@carafelliconsulting.com