Negotiating payment terms between carriers, physicians, hospitals, and governments is a high-stakes effort, and each side knows it. The technical aspects of contracts can be decisive, and today’s complex contracts often contain traps for the unwary. Milliman consultants are experts at complex negotiations and provide clients with detailed analyses grounded in financial realities. As well, our reputation as unbiased experts can help smooth the process of reaching agreement.

Actuarially sound capitation rates

Milliman consultants have developed actuarially sound capitation rates for many state Medicaid programs and managed care organizations. These programs use the capitation rates we develop to contract with payers. We also provide support during the contracting period as terms of the contract evolve.

Our evaluations are based on real information

Governments—federal and state—are among the biggest payers. We have assisted clients, ranging from providers to managed care organizations, through negotiations by determining the financial implications based on actuarially sound analysis. These typically consider needed services, historical experience, and ongoing changes in coverage, demographics, costs, and technology.

Our experts bring best data, analysis, insights

One large integrated delivery system, which receives a major portion of its income through capitation, came to Milliman for help in renegotiating its rates with payers. We used our actuarial expertise to reconstruct the payers’ financial results and demonstrated the profits earned through their rates. We also created scenarios to test the impact of potential payer mergers. These analyses allowed the client to significantly bolster its income.