Exclusive Direct Provider Contracting

PremierSource has the great fortune of serving as the advisor and consultant for a number of hospitals and healthcare providers across the region. Over the years, this industry exposure has allowed us to develop a niche experience from inside the tent of our healthcare system. Our team’s further in-depth knowledge of network and managed care contracting uniquely positions us to identify opportunities for employers that cut through the red tape and create unparalleled transparency that has previously not been available in the history of employer-provided healthcare.

Using our PremierSource Advantage care management system, we have followed provider performance trends for the past several years. This trend monitoring allowed us to identify that certain providers continued to appear on our “top provider performance” list for maintaining efficient pricing and favorable outcomes year over year. We further identified some of the same providers continued to appear at the bottom of the list by having net charges outside the expected norms for given diagnostic risk groups and/or episodic treatment groups year over year. This prompted us to perform further research to identify how certain providers were creating efficiencies and to question whether our employer clients could benefit from direct contracts with the best-in-class providers.

The result of this study led us to negotiate direct contracts with several of the top performing specialty providers who were willing to give us a transparent, pre-negotiated fee schedule based on a “cash payment” system versus a “percent of Medicare” or versus a “discount from billed charges” system. The net results of the “cash payment” contracts have been incredible as we learned that the net cost of our contracts per procedure is often less than the deepest discounts from billed charges that many other providers offer through PPO networks.

Our strategy was to keep it simple on the provider thereby creating efficiencies on their end that could result in savings passed on to our employer clients. Several of these contracts are offered on a transparent, bundled payment schedule whereby a patient can know before going in for surgery the exact cost of the procedure “all in,” including anesthesia, physician services, facility fees, etc. NO games, no discounts from inflated billed charges — just the bottom line asking price for a cash-based procedure.

We now make these exclusive PremierSource direct contracts available to our self-funded clients who want to create their own performance-based networks. In conjunction with these contracts, we help employers establish plan designs and creative case management strategies to help drive efficient utilization and quality outcomes.

Please note: most independent third party administrators accept these contracts at no additional fee for administration. Most carrier payers are not able to accept these contracts, so additional fees may apply for the administration of these contracts as an add-on to a carrier administered plan. Please contact a PremierSource representative for more information.