Why looking at financial contribution alone can conceal a major reimbursement opportunity

Alexandra Criscione, Director If a payer steers patients away from your health system, what is your discount buying? The payer wants the discretion to designate your health system as out-of-network while retaining your in-network discount. You receive discounted reimbursement while patients receive financial incentives to go elsewhere. Before you sign, ask the direct question: What are you receiving in exchange for the discount? That question gets to a bargain that has

Robert A. Dickinson, Managing Director, BDC Advisors Intractable healthcare trends, often undetected or ignored by healthcare executives, will eventually become structural problems for healthcare enterprises if not addressed intentionally: Structural margin pressure Practice of medicine in crisis Decentralized care models Ecosystem coopetition Each of these trends requires a reevaluation of strategic priorities, reallocation of people and capital resources, and likely, restru

Shawn Fitzgibbon, Managing Director, BDC Advisors Health insurance markets are changing in ways that directly affect health system margins, revenue predictability, and patient access. Payers are exiting markets, narrowing product offerings, and adjusting strategies across Medicaid, Medicare Advantage, and ACA exchange plans. For CEOs and CFOs, these shifts are no longer simply managed care issues. They are enterprise financial risks that require a market-specific response bef

Alexandra Criscione, Director, BDC Advisors If you are a health system CFO, you are likely being asked a harder question than you were five years ago. Not simply: “Can we get the payer renewal done?” But: “Will this renewal sustain the enterprise?” That is a different question. And it requires a different way of thinking. For years, traditional renewal strategies assumed a relatively stable environment: predictable labor costs, manageable inflation, modest annual rate movemen