Payer economics
Is this platform paid what its book is worth, and can it lift that?
Structure
Fixed scope per build
Delivery
Embedded
Output
Contracted and realized unit value
Any one of the four can be the whole build, once the diagnostic has sized it.
What's actually going on
A boutique gets a platform a better rate once. The contract is signed and the work stops there.
Nobody changed which payers the platform is concentrated in. Nobody designed the network the next arrangement will need. And nobody made contracting something the platform does on a calendar rather than something it does when a contract is about to lapse.
So the rate improves and the unit value does not, because rate is one of three inputs and the other two were never touched. Mix is a service, market and referral question. Network position determines whether a risk arrangement is even available to ask for.
What gets found, built and proven
01
Find it
What the assessment finds
Payer Contract Inventory Register
Every commercial agreement with its terms, rates, escalators, and renewal and termination dates.
Rate Gap Analysis
Every rate normalized to a percent of dated Medicare, ranked by gap times volume, positioned against market benchmarks and against what the same service earns at a different site of service.
Market and Leverage Analysis
The platform's negotiating position by payer and market: network position, volume, and adequacy.
Medicaid Floor Audit
Confirmation the platform is paid to the published state floor.
Realized-Rate Reconciliation
Contracted against paid, with the billing system configured so underpayments stay visible.
Board-ready rate readout
Where the dollars are, what is realizable now, and the sequence to capture them.
02
Build it
What gets installed
Renewal Calendar
Every renewal and notice deadline, and the date to begin each renegotiation.
Renegotiation Roadmap
Which contracts to work and when, with a target rate and the leverage angle for each.
Rate-Review Cadence
The recurring session that sets targets, tracks realized results, and reports rate performance.
Credentialing remediation
The gap list by provider and payer, a named owner, and the recurring check that keeps rosters current. Your team runs it.
Payment integrity surveillance
Standing detection of underpayment and payer policy change, with each pattern routed to an owner and a date. Working individual claims to cash is revenue-cycle work and stays with your team.
Network and product design
The structure a risk or value-based arrangement requires, where the platform is pursuing one.
03
Prove it
What the ledger shows
The benefit ledger
Rate improvement contracted, rate improvement realized in collections, and the reconciliation between them, co-signed with the CFO.
The exit record
A contract inventory, a renewal calendar, and a documented history of realized rate movement.
When this tends to be the right call
At close
The platform is still paid at rates it signed before it had any scale, and no contract has been reopened since.
Contracts sit in three people's files and nobody holds the inventory.
Early hold
Nothing in the scheduling system stops an uncredentialed clinician from being booked into a billable session.
Nobody holds a calendar of renewal and notice deadlines, and contracts auto-renew before anyone opens them.
Mid-hold
Rate performance is reviewed when someone asks, and no standing session sets a target or checks what was realized.
Payer mix is a percentage on a slide and nobody can say what a unit earns under each payer.
What is your book actually worth?
Start with a short diagnostic on this area. It sizes the gap before anything gets built.
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