Explore Our Services
Payor Contract Portfolio Review
After a thorough review of your claims and contracts with your payors, House Actuarial will provide a report comparing the viability of each contract and advising on future contracting strategy.
Strategizing insurance contracting is an important part of medical practice, but most providers don’t have the time or resources to invest in it. It’s also complicated, requiring consideration of, for example,
The prices allowed in the contract, compared to others,
How many patients the payor brings to your practice,
The services these patients use, and
When in the year they see you.
House Actuarial has experience in evaluating insurance contract profitability, considering all of these factors and more. This service includes:
After an initial consultation, House Actuarial will work with your practice to securely collect the necessary data, in compliance with HIPAA.
We will produce a report on the current viability of your contracts, containing recommendations for future contracting strategy.
House Actuarial will provide a one-hour final consultation to discuss the results of our analysis.
Strategizing insurance contracts is complicated. House Actuarial can make it simple.
Pricing
When you partner with us, we set our prices based on the complexity of your practice:
Starting at $2,000 for practices with 1–3 providers
Starting at $3,500 for practices with 4–8 providers
Starting at $5,000 for practices with 9+ providers
After the initial consultation, we will finalize the pricing based on payor mix and contract complexity.
Value-Based Care Opportunity Evaluation
House Actuarial will work with your practice to evaluate a proposal for value-based care, where you are compensated based on outcomes rather than volume.
Most healthcare providers have been offered a value-based contract at one point or another, but have turned it down because:
They’re afraid of being exploited,
They’re concerned about downside risk, or
They can’t assess the reasonability of the offer.
House Actuarial brings clarity to your decision, ensuring you are well-informed before you make any agreements. Then, with value-based care, your practice can benefit from the quality of your services, so you can care more attentively for each patient. This service includes:
After the initial consultation, House Actuarial will carefully review a proposed contract, highlighting any concerning terms.
If the contract is reasonable, we will forecast your profitability under the contract, working with you to collect necessary data, in compliance with HIPAA.
You will receive a report outlining your projected profitability, potential risks, and recommendations on maximizing your benefit under the contract.
House Actuarial will provide a one-hour final consultation to discuss the contents of the report.
Value-based care can feel risky and uncertain. House Actuarial can bring confidence to your decision.
Pricing
Due to varying complexity of value-based care contracts, this service is priced hourly. After the initial consultation, we will provide an estimated budget based on your practice’s needs.
Shared Risk Reconciliation Support
House Actuarial will actuarially support you as a health plan reconciles your shared risk arrangements, pays capitation, or pays out quality bonuses.
At the end of every year, health plans reconcile their contracts with providers. They send detailed actuarial reports that involve sections such as:
Baseline costs,
National trends,
Pharmacy adjustments, and
Many others.
House Actuarial has experience with these reconciliations and the consequences of imbalanced actuarial support. The health plan may put a lower trend than you are entitled to, inconsistently exclude services, or fail to adjust for new, expensive drugs that affect your bottom line.
We can support your negotiations, ensuring that your practice's stance is strong. This service includes:
After the initial consultation, House Actuarial will carefully review the health plan’s proposed reconciliation terms.
We will review the contract in comparison with the terms and produce a report outlining the major components of the reconciliation, any concerns with these components, and our estimate of a fair reconciliation.
House Actuarial will provide a one-hour consultation to discuss the contents of the report.
At your discretion, we will then communicate our findings to the health plan.
Health plans are armed with actuaries to get the best results they can from these contracts. House Actuarial can bring that credibility to your practice.
Pricing
Due to varying complexity of shared risk reconciliations, this service is priced hourly. After the initial consultation and at every step, we will provide an estimated budget based on your practice’s needs.
Get In Touch
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