Provided Network Development Support to a large national health plan to expand their workers compensation physician and facility-based provider network.  Effective price negotiation was key to the success of the effort.

Assisted a large regional health plan in developing a private-label workers compensation provider network in New York and New Jersey at payment rates at or below the competition.


Utilized our data mining capabilities to measure a large national health plan's hospital pricing against that being paid by its competitors.  The standard Medicare cost report and other information available in the public domain was used to provide the source data for this analysis.

Engaged by a large national health plan to negotiate payment rates with large hospital systems in California, Texas, Virginia, New York and New Jersey.

Negotiated hospital rates and contracts with select New York hospitals and IPAs for regional HMO. This contracting effort allowed the New Jersey members of the health plan to have “in network” access to high quality New York tertiary care facilities.    

Planned and developed organizational structure, marketing programs and a provider network for a start-up MCO. This project successfully contracted with over 35,000 physicians, 1,250 ancillaries, and 256 hospitals growing membership to over 800,000 throughout New York and New Jersey for Health Benefit and Workers Compensation programs.

Assisted a Michigan-based health plan to initiate a physician re-contracting effort. OnPoint dispatched staff to work on-site in Michigan. This effort allowed the client to undo an unfavorable business relationship with a local IPA.

Assisted a large national managed care plan to achieve the following in the NE Region: a). Negotiate a contract rate renewal for a multi-hospital system in NY, b). Contracted with hospital-based physician groups with high out-of-network spend, and c). Recruited 3,500 non-participating physicians into their provider network. This effort has resulted in significant reductions in out-of-network spend and future claim cost trends.

Assisted a National Medicaid Managed Care Plan in entering the New York market by developing a 3 county hospital and physician network. Project results include recruiting over 1,300 physicians (Primary & Specialty) in less than 90 days. The client completed a successful IPO and secured a license in New York State.

Contracted with Radiology, Anesthesiology and Pathology groups (RAPs) in both New York and New Jersey for a major national HMO. This contracting project has saved over 20% of out-of-network spend for this payor.

Engaged by a local provider-sponsored Medicare Managed Care Plan to develop a revised Provider Relations Manual and a carve-out vendor performance measurement tool. This effort has resulted in significant reductions in out-of-network spend and future positive claim cost trends.

Conducted phone-based physician marketing effort on behalf of a national provider of secure online health care communication services providing online medical consultations between physician subscribers and their patients. This effort has allowed client to supplement existing marketing staff efforts and increase physician recruitment into their program.

Engaged by a large physician group of retinal surgeons in New Jersey to assist them in negotiating payment rate increases with all commercial insurers.  This activity resulted in a 20% increase in total practice revenue.

Retained by two local community hospitals, one large rehabilitation center and a freestanding ambulatory surgery center to provide regular weekly managed care contracting support as well as physician credentialing services. This effort has allowed all these clients to engage well-experienced managed care staff who have assisted them, in all cases, to increase revenue from third party payors.

Engaged by a large orthopedic group in New York to assist them in securing payment rate increase for their professional activities as well as a fluoroscopy service recently initiated.  This activity resulted in a significant increase in their revenue streams.

Perform outsourced credentialing services on location at Skilled Nursing Facilities and Ambulatory Surgery Centers throughout the tri–state area for major health insurer. This service enables our client to maintain accredited providers and continue to meet NCQA standards.

Built a hospital and physician network for a local CMS-certified PSO (Provider Sponsored Organization) to expand into the 3-county Albany Capital District. This effort allowed the client to file for expansion of its Medicare PSO license  into the Albany Capital District by the CMS filing deadline date.

Engaged by a office-based surgical GI practice in New York to assist them in securing payment rate increases for their professional activities and to secure a “suite fee” and/or a “surgical tray fee” for their office-based surgical activities.

Assisted a National Workers’ Compensation and Auto Network in expanding their network throughout all 50 states, recruiting all applicable specialties

Negotiated contract rates for all offered products, using strategies tailored to each state

Compiled and reviewed credentialing materials for all new contracts, streamlining the build of the network

Currently working with a national insurance carrier on their goal to amend all provider workers’ comp and select auto contracts. As a result of the acquisition, our client consolidated their workers’ comp and auto product lines into an LLC making it necessary to amend all provider contracts to one legal entity. To date, OnPoint has secured 19,642 signed Addendums and Amendments for existing agreements, resulting in savings of close to $400 million.
 

We have been engaged by two large national health plans to perform rate parity/assurance audits of rate agreements executed with two large well known university hospital-based physician practices in New England.

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We have been engaged by the Board of a nursing home in Westchester, NY to assist the Finance Department in pursuing and completing a number of projects including but not limited to mortgage refinancing, professional liability, general liability and property insurance renewals, investments’ analysis, etc.

 

Working off of a targeted provider recruitment list of over 10,000 physicians and chiropractors, we have been engaged in a provider recruitment effort in the states of Arizona, California, Georgia, Illinois, Kentucky, Massachusetts, New Hampshire, New Jersey, New York, North Carolina, Ohio and Rhode Island. This work was being done to enhance the competitive value of the provider network for a large national health plan.

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Through an electronic downloading procedure, we have assisted a large national health plan confirm the relative competitive position of their payment rates to large medical groups located in the states of Connecticut, New Jersey, New York and Massachusetts.

 

We have been engaged by a nursing home sponsored PACE program headquartered in Bronx, NY to assist them in recruiting additional physicians to satisfy federally mandated distribution of physician specialties by county and to assist in negotiating selected hospital contracts.

 

We have been engaged by a large national substance abuse/rehabilitation/residential provider to conduct comprehensive managed care contract analysis, prepare applications for participation and re-negotiate initial rates and contract terms with various health plans and mental health/substance abuse carve-out networks.

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We helped a provider-based managed care organization recruit and contract with a sufficient number of hospitals, physicians and ancillary providers allowing it to file for an SNP license with CMS in a specific County of New York City.

 

We are assisting a Medicaid managed care organization recontract with a large number of its participating hospital providers. The purpose of the recontracting is to update its contract language so that it is consistent with State-mandated contract provisions.

 

Working off of a targeted physician recruitment list of over 10,000 physicians, we are engaged in a physician recruitment effort in the States of California, North Carolina, Massachusetts and New Hampshire. This work is being done to enhance the competitive value of the physician network for a large national health plan.

 

We have been engaged to review the claims file of a large national health plan for purposes of confirming the relative competitive positions of their facility payment rates in the State of New Jersey. Through an electronic downloading procedure, we were able to analyze the needed information securely and expeditiously.

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A national Medicaid managed care organization has engaged us to help them recruit a sufficient number of physicians in the State of New Jersey so that they can satisfy the State-mandated distribution of physician specialties by County and to also help to make their Medicare managed care program more marketable.

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A large national health plan has engaged us to help them to expand their physician network in the State of New Jersey t make the network competitive with the market.

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We are currently providing managed care contracting support to a hospital system, a number of individual hospitals, nursing homes, home health care agencies, imaging centers and ambulatory surgery centers. This support runs the gamut of negotiating increased rates to providing detailed analytical and ‘what if’ modeling to identifying payments at less than agreed upon rates to physician credentialing.

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We assisted a national Medicaid managed care plan entering the New York metro market by developing a tri-county hospital and physician network. We helped to recruit 1,300 physicians (primary & specialty) in 90 days. The client completed a successful IPO and is in the final stages of applying for licensure in New York State.

 

We contracted radiology, anesthesiology, and pathology groups (RAPs) in New York and New Jersey for a major national HMO client. This project has reduced out-of-network spending by 20%.

We were engaged by a local nurse placement agency to assist in structuring a foreign nurse recruitment program and in marketing their services to hospitals and other health care facilities in the U.S.

 

We were engaged by a Medicare Managed Care Plan to develop a revised provider relations manual and a carve-out vendor performance measurement tool. This effort will allow the client to negotiate more favorable renewals with the carve-out vendor network.

We conducted a physician marketing effort for a national provider of secure online health care communication services to support online medical consultations between physician subscribers and patients. This effort has allowed the client to rapidly increase physician recruitment into their program.

 

We helped a Michigan-based health plan initiate a physician re-contracting effort. This effort allowed the client to improve business relationships with a local IPA.

 

We assisted a large national managed care plan to negotiate a contract rate renewal for a multi-hospital system in NY. We recruited 3,500 non-participating physicians into their provider network, resulting in significant reductions in out-of-network spending and helping to control claim cost trends.

 

We negotiated hospital rates and contracts among New York hospitals and IPAs for a regional HMO. This assignment allowed the New Jersey members of the health plan to have “in network” access to quality New York tertiary care facilities.

 

We planned and developed an organizational structure, marketing programs and a provider network for a start-up MCO. This project successfully contracted with over 35,000 physicians, 1,250 ancillaries, and 256 hospitals and increased membership to over 800,000 throughout New York and New Jersey.

 

We conducted outbound data verification program for a national MCO while introducing the use of web-based tools. The project realized a 100% success rate targeting network physicians throughout the Northeast.

 

We perform outsourced credentialing services at Skilled Nursing Facilities and Ambulatory Surgery Centers for a major health insurer. This service enabled our client to maintain accredited providers and continue to meet NCQA Standards.

 

We built a hospital and physician network for a local CMS-certified Provider Sponsored Organization to expand in the Albany, NY area. This effort allowed the client to file for expansion of its Medicare PSO license by the CMS filing deadline.