Healthcare: managed care: private equity

Managed care: private equity: private equity

March 23, 2018

Challenge:

The client required a comprehensive assessment to validate the financial viability of acquiring a multi-site radiology practice and executing a strategic partnership with a hospital. The parties were interested in converting the imaging sites to hospital outpatient locations. This required:

  • Analysis of existing payor contracts to determine reimbursement rates, product participation, assignment language and termination provisions
  • Validation of reimbursement rates in comparison to market averages, including overlapping contracts with the hospital partner
  • Exploration of alternative reimbursement methodologies and recommended strategies to develop a payor/provider partnership
  • Survey payors to obtain feedback on the proposed partnership, including conversion of payor agreements under hospital TIN# for outpatient services

Solution:

Mazars assembled a team of managed care professionals to execute the outlined strategy. A critical component of the due diligence was the ability to leverage relationships with key payor contacts and conduct interviews to determine the viability of the client’s strategic objectives. Our team delivered the following as part of the assessment process:

  • A detailed payor matrix to assess reimbursement (professional/ technical components), contract terms, and highlight favorable opportunities and potential concerns
  • Identified advantageous financial positions in comparison to current market-based rates for community providers and competing radiology networks
  • Detailed opportunities to negotiate enhanced reimbursement rates
  • Identified issues that could adversely impact specific payor relationship

Results:

We delivered a strategic assessment, on time and within budget, to all applicable parties including the private equity firm, target portfolio entity (radiology provider) and partner hospital

  • Our private equity client was provided with a comprehensive perspective on the feasibility of moving forward with the proposed strategy