The healthcare landscape today is extremely dynamic and achieving maximized reimbursement from regional healthplans is increasingly challenging. New strategies and a fresh approach to managed care contract negotiations are required. Unlocking value through the delivery of cutting-edge negotiating strategies is the founding principle of our firm.
About Us
The Carlisle and Associates team has the contract negotiating experience, and the knowledge of both the provider and payor markets, to better equip hospitals and physicians during and after their negotiations - delivering substantial revenue gains and improved working relationships with their managed care payors. A track-record of success and a growing client roster, gives us the highest confidence that our contract negotiators can produce results that exceed what providers could achieve on their own, or with alternative consulting services.
Our negotiators know how to manage the negotiations process and structure an agreement that balances a provider's need for maximized reimbursement, with the healthplan's need to control medical costs. This body of knowledge and expertise was developed while operating at the highest levels of managed care contracting and healthcare delivery for over 25 years.
Our senior-level expertise is available exclusively on behalf of healthcare providers. While we maintain positive working relationships with managed care plans, we do not represent them as clients. The team is equipped with the knowledge base and capacity to represent all types of providers, including major hospital-based health systems, community hospitals, physician subspecialty groups, ambulatory care centers, home health agencies and more.
Our fee structures are based upon the scope of the engagement and may include a combination of a fixed fee and a variable fee based on objective milestones met.
How We Work With Clients
- Prior to engagement we will analyze the prospective client's recent managed care utilization data and provider agreements, in order to assess the prospects of increased reimbursement and the best way Carlisle and Associates can provide value during negotiations.
- Based on this assessment, Carlisle and Associates will prepare an engagement letter which clearly spells out the scope of the assignment, the work to be performed and related fees - including the method of determining such fees.
- Upon execution of the engagement letter, Carlisle and Associates will work with the client to develop specific goals and timetables for the negotiations and initiate the engagement.
- Upon completion of the assignment and client's execution of the new managed care contracts, Carlisle and Associates will provide the client with a detailed report documenting the results of the negotiations.
Throughout the term of the negotiated contract, Carlisle and Associates will provide ongoing support to ensure the client is paid as specified by their provider agreement.