Payer mix and contracts

What you'll get

• Your payer mix benchmarked vs. specialty + regional peers (percentile rank per payer)

  Assumes: Benchmarks pulled from MGMA + state-level commercial data where published; private-pay regional plans flagged as 'estimated'.

• Rate-gap analysis on your top 10 CPT codes vs. market median ($ per encounter)

  Assumes: Market median uses regional commercial benchmarks or Medicare × typical commercial multiplier when commercial data is thin.

• Top 3 contracts ranked for renegotiation by likely $/year uplift × success probability

  Assumes: Success probability weights volume share, contract age, gap size, and your local market leverage (typically 30–70%).

• Patient-acquisition tactics to shift mix toward your 2 highest-paying payers

  Assumes: Tactics scoped to digital + referral channels; does not include paid-search budget recommendations.

• Renegotiation script + 2-page data packet you can send your top-priority payer

  Assumes: Script is a starting point — final tone and language should match your existing relationship with the payer rep.

How we build it

1. 1We use regional commercial benchmarks (where published) and Medicare-equivalent ratios to estimate where each contract sits.
2. 2Renegotiation candidates are scored on volume share, contract age, and gap size — small low-volume contracts are deprioritized.
3. 3We never tell you to drop a payer without modeling the patient-volume impact first.

What we'll ask in intake

• Approximate payer mix by % of revenue
• Top commercial contracts and last renegotiation date (if known)
• Top 10 CPT codes by volume
• Your geographic market and specialty

No PHI required. Aggregates, percentages, and estimates are enough.

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