Market Positioning and Payer Strategy Case Study

This case study outlines the engagement of SCALE by a home health service provider specializing in post-acute care. The objective was to assist with payer contract review, rate negotiation, and market positioning across Medicare Advantage and Commercial lines of business. The client, a leading home health nursing agency in orthopedic care recovery, faced challenges due to increased patient volume and lagging reimbursement rates. SCALE's Payer Strategy team analyzed the home health market and the client's current payer agreements to develop an effective rate negotiation strategy. This involved obtaining clinical and performance outcomes, reviewing payer contracts, and researching the client's market positioning. The results of the negotiations included increased commercial rates with two major payers and more favorable contract terms. Additionally, ongoing negotiations with two other payers aim to secure better rates and contract language, while SCALE is coordinating future contract negotiations for 2024.