Athena Group Consulting LLC

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Monday – Friday, 8:00 a.m. – 5:00 p.m.
Weekends by Appointment


It takes work to achieve efficiency and profitability in the health care industry. We show you how to incorporate health plan contracts and medical management staff into a winning strategy.

What’s Broken in Health Care: Instituting True Risk-Based Payments

Full Article

In a time where many in this nation are confused about the direction of Health Care we look toward the future. Regardless of the design one thing is clear, we need more accountability in health care. There still isn’t a clear understanding of risk-based contracting in the healthcare industry. This value-based payment model is inevitable and will ultimately shape the future of healthcare in a way that will be mutually beneficial to patients, providers, and payers. So why are the details still so murky and where does all the trepidation come from? As with many visionary endeavors, risk sharing can require heavy collaboration, strategic planning, complex contracts, a slow return on investment, and uncertainty in the near term. In a word, risk.


Hospital Contract Assessment

The hospital had a recent turnover in contracting staff. There was no source of contracting terms and conditions.

Problem Assessment
The hospital was losing out on additional revenue, due to the lack of managing the renewals of contracts. Several contracts had pending renewals that had missed the renewal date and had not been finalized. One contract had been completed but never returned to the hospital and rates never loaded.

A complete contract assessment of all health plan contracts was performed, including key provisions such as rates, last renewal, effective date and other operational issues. A complete assessment was documented and provided to the hospital. This assessment included a write-up for each health plan contract. The write-up included a summary of the position of the contract and actions needed. Actions included operational improvements and re-contracting if needed.

Contracts were updated with better terms and rates. A tracking system was devised to track renewals and status of contracts until final loading by health plan and filed by the hospital.

IPA Physician Re-Contracting

IPA Specialty Physicians were almost entirely capitated. The Specialty costs needed to be contained.

Problem Assessment
The Specialty Physician capitation was not in line with IPA revenues and provided no incentive to control cost.

Physician With a Patient

A competitive assessment of capitation rates and range of services by specialty was performed. The assessment was translated into new rates, and a risk pool distribution percentage was also calculated. Specialty Physicians were contracted at new rates. Rates were also tied to revenue. The revenue tie-in provided an incentive for the physicians to help the IPA gain more from the health plans. Also, as the physicians now shared in risk pool distributions, they were more aware of actions on the entire IPA financials.

Action results include completion of re-contracting in three months, reduction of expenses, and enhancement of revenue. An added benefit was the increase in customer satisfaction. The physicians had an incentive to keep patients happy as well as maintain a good IPA reputation. The improved customer satisfaction enabled contracting staff to get larger increases, putting more dollars in the physician's hands.

IPA Administrative Cost Reduction

IPA Operations were inefficient and not responsive to customers. Administrative costs were running 16% of revenue.

Problem Assessment
Operational staff was aligned by function. They could not understand the details of the health plan contracts. They also did not communicate with other departments. The operational disconnection created a significantly long time to resolve issues. It resulted in the identification of duplicate work efforts.

We placed staff from all areas, including Claims, Customer Service, and Medical Management on teams. The teams were aligned according to health plan. The teams were then trained on the details of the health plans they managed.

Staff was reduced, the accuracy of work was improved, and the time to resolution was improved. Overall administrative costs were reduced from 16% to 11% of revenue.

Contracting Article
Completing managed care negotiations on time and securing great terms is often a struggle for hospitals and IPAs. Why? Because most management teams are already stretched thin, and it can be nearly impossible to find the time to research market rates and engage in effective negotiations. In the end, negotiations are often completed late and result in below-market rates.


Visual Health SolutionsVisual Health Solutions, Inc. is focused on patient / physician engagement through the use of compelling visual content so that the message is clear and easily understood. 360 advisory groupThree-Sixty Advisory Group, LLC is committed to doing its part to transform the health care system to deliver on the aims of: better quality, improved satisfaction, lower cost, and better access to health care.

Med-Vision Soutions - Quick Cap

Here's how QuickCAP can make your world oh so much easier: Simplify contracting and rapidly check provider credentials. Streamline claims work every element of a claim is at your fingertips. Improve care coordination with efficient information flow and a bird's eye view of the team. Easily generate common-sense reports to position yourself to gain new business