Empowering Neurologists Nationwide

Introduction

Tribunus Health has been partnering with specialized healthcare providers – including neurologists – across the United States to enhance their practice performance and negotiate better rates with payers. Our unique approach has benefited neurological practices nationwide, addressing the specific challenges they face in today’s healthcare landscape.

Challenges

Neurologists face increasing pressure to demonstrate value while negotiating fair compensation from payers. This pressure stems from several factors:

1. Complexity of Neurological Care: Neurological conditions often require long-term, complex care plans that can be expensive, leading payers to scrutinize costs closely.
2. High-Cost Treatments and Diagnostics: Many neurological treatments and diagnostic tools (e.g., MRIs, specialized medications) are expensive, prompting payers to demand detailed justification for their use.
3. Outcome Measurement Challenges: The progress of neurological conditions can be difficult to quantify, making it challenging for neurologists to demonstrate value to payers in concrete terms.

Many neurologists lack the resources and expertise to effectively analyze their data and differentiate their services in the market, leaving them at a disadvantage in payer negotiations.

• Neurologists are increasingly vital due to the aging population, which has led to a rising prevalence of neurological disorders.
• They play a crucial role in interdisciplinary collaboration, providing essential insights that inform comprehensive patient care across various specialties.

Solution

Recognizing the unique challenges faced by neurologists, Tribunus Health deploys its comprehensive strategy to support these vital healthcare providers. Our approach is always tailored to address the specific needs of a client:

1. Accurate Data, Expertly Interpreted. We collect and analyze comprehensive data, including competitor payment rates by code and payer, patient outcomes, treatment efficacy, and operational metrics. Our team of experts interpret this data to provide actionable insights.
2. Value Proposition Development and Differentiation. Using our analysis of the price transparency data coupled with a greater understanding of key differentiators that payers care about, we craft compelling value propositions, highlighting unique strengths and demonstrating their value to payers and patients alike.
3. Determined Pursuit of Improved Rates. Armed with accurate data, strong value propositions, established relationships with payers and clear objectives, our team persistently negotiates with payers to secure improved reimbursement rates.

Pete Wallach, Co-Founder and CFO of Synapticure, states:

Tribunus has been an accelerating partner for our business over the last few years, helping us achieve national reach for patients across payer types. We couldn’t have asked for a better partner to launch our services and get in-network.”

Accurate Data, Expertly Interpreted

Leveraging price transparency data and a unique value proposition, we craft a compelling case for optimal payer contract fee schedules.

For example, the graph below shows the distribution of rates from United Healthcare Group related to code 95857 for neurology providers in Texas.

With the comprehensive market data, we can effectively challenge payers’ claims of uniform or optimal rates, ensuring fair compensation for services.

The United “market” for Neurologists in Texas shows signs of relative efficiency, meaning that providers have the ability to achieve higher (or lower) rates based on their relative value.

Identifying Obstacles and Opportunities

As a point of comparison the BCBS “market” for a common ophthalmology code shows high levels of price stickiness. Providers in markets like this will have a harder time escaping the gravitational pull of the payer’s fee schedule.

Informed Expansion Strategies

Many providers use our price transparency tool when considering entering new networks. Our solution empowers healthcare providers to make data-driven decisions when selecting payers, optimizing their network strategy, and maximizing revenue.

• Prioritize which payers – in which markets – to target
• Develop pro forma revenue models with greater specificity
• Identify underpaid physicians and groups for business development

By leveraging comprehensive market data and pricing information, organizations can strategically evaluate and optimize payer options, accurately forecast revenue, and identify opportunities for growth in an increasingly complex healthcare landscape.

Why Choose Us?

Why Choose Tribunus Health? When considering Tribunus Health as your partner in healthcare reimbursement and contract negotiations, here are the key differentiators that set us apart:

Unparalleled Data Expertise. Through our partnership PayerPrice, we created a highly customized, advanced platform to provide visibility into every commercial contracted rate by every provider in the country.

Comprehensive Payer Market Knowledge. Advisor into which markets to pursue and which payers to approach based on market share and likelihood of success.

A Valued Strategic Partner. Clients choose Tribunus because they want more than a vendor, they want a partner who represents them and advocates strongly on their behalf.

Negotiation Skills. Tribunus has a team of 30+ expert negotiators who know how the game is played with payers and how to position clients for optimal success.

Experience and Track Record. Deep experience with over 10,000 completed contract negotiations. Average increase is 13.1% for completed negotiations.

Time and Resource Optimization. Tribunus takes this work completely off the plates of Clients so they can focus on running their healthcare organizations.

Contract Analysis and Advocacy. Tribunus analyzes contract offers to ensure that the best offer proposals from payers actually have a material impact on the revenue of Clients.

Market Access. Clients choose Tribunus if they desire to enter new markets as quickly and efficiently as possible. Usually clients can obtain new contract offers within 3-6 months from kickoff.

A Dedicated Account Team. Tribunus supports Client’s with a dedicated team that scales to meet their needs, from single market negotiations to those operating across 50 states. Our flexible model ensures consistent communication and regular updates, leading to optimal results.