Managed Care Black Box Analysis & Reimbursement Analytics

Black Box Analysis: What is it?

A black box analysis provides insight into any potential changes in an organization’s managed care revenue by modeling payor contract payment logic for two organizations on historical utilization data.

The Problem

As buyers and sellers approach a transaction, or operators contemplate changes within their existing business, it is critical for the parties involved to quantify the potential impact to existing revenue, specifically as it relates to a business or service line’s contract reimbursement.

Gaining clarity can be a challenge for buyers and sellers due to anti-trust restrictions and confidentiality concerns as contractual reimbursement terms and rates are proprietary. In addition, operators may not have internal capacity to evaluate critical items, such as current contract performance, alternative pricing strategies and the competitive landscape.

Finding an independent third party that understands payor contracts and the data required to develop an analysis that provides meaningful results in a timely manner is also challenging.

The Solution

VMG Health has an experienced team with the knowledge required to provide clients with detailed insight into reimbursement differentials across any service line and site of service to help enable your organization to make strategic decisions based on data-driven analysis.

Examples

VMG has provided black box and other reimbursement analyses for operators, buyers, and targets’ contracted payor reimbursement across multiple businesses and service lines related to (but not limited to) the following:

  • IP/ OP Hospitals
  • Hospital Service Line/ Department Carve-Outs
  • Outpatient Surgery Centers
  • Medical Groups & Practices
  • Urgent Care Centers
  • Outpatient Catheterization Labs
  • Radiation Oncology
  • LTACHs
  • Other Outpatient Services
  • Chargemasters
  • Conversion Impact of Out-of-Network to In-Network Reimbursement
  • Site of Service Differentials
  • Contract Optimization

Contact Nick Tagioli for more information about Reimbursement and Black Box Analyses.