Transforming Payer Contracting and ASC Access for a Multi-State Ophthalmology Group

Introduction

A multi-state ophthalmology group with approximately 25 practices/99 locations and 9 ambulatory surgery centers (ASCs) partnered with Tribunus Health to improve contracting performance, streamline administrative processes, and lay the groundwork for sustainable growth. What began as a clinic-focused engagement quickly evolved into a broader partnership, supporting both clinic and ASC operations through payer negotiations, contract organization, and data-driven prioritization.

Together, more than 70 contracting processes have been completed across two years—delivering over $1 million in estimated revenue gains. Among these efforts, the organization’s ASCs in Nevada and Texas gained access to previously restricted payer networks and saw significant rate improvements that directly boosted patient access and financial performance.

Client Background

Our client is a leading ophthalmology platform offering comprehensive clinical and surgical eye care services. With over 90 clinic locations and 9 ASCs across multiple states, the organization operates in a coordinated care model—routing patients from clinic evaluations to ASC-based surgical procedures such as LASIK and advanced ophthalmic surgeries.

As the organization expanded its footprint, internal resources became strained, and they looked for a strategic partner to help stabilize and scale their contracting infrastructure while supporting both clinic and ASC performance.

The Challenge

1. Overextended Internal Teams: Managing dozens of payers across multiple markets left minimal bandwidth for renegotiations or expansion.
2. Aging Contracts: Many agreements—particularly at the clinic level—hadn’t been updated in years, resulting in stagnant rates and missed revenue.
3. Fragmented Visibility: Without a centralized repository, tracking contracts, rates, and payer activity was difficult and time-consuming.
4. Referral Disruptions: Limited payer participation at certain ASCs prevented providers from directing patients to their own surgical centers.
5. New Services, New Complexity: Launching emerging services like corneal crosslinking required proactive outreach to secure appropriate reimbursement.

The Approach

The engagement began in 2022 with a focus on clinic-level contracts. As results took shape, the scope organically expanded to include ASC contracting in Nevada and Texas, as well as credentialing support and strategic payer guidance.

Key elements of the collaboration included:

1. Revenue-Based Prioritization: Contracts were ranked and tackled based on utilization and revenue potential, ensuring early wins and efficient deployment of internal and external resources.
2. Contract Management Infrastructure: A centralized system was implemented, organizing contract documents, fee schedules, and payer updates for easy internal access.
3. Ongoing Expansion Support: New locations and service lines were integrated into the contracting roadmap. Market-specific payer strategies were developed to address gaps in participation and coverage.
4. Strategic Advisory: Regular check-ins and shared dashboards enabled the client’s leadership to align priorities, track outcomes, and adjust course based on emerging payer trends.

The Results

1. More than $1 Million in Estimated Revenue Gains from 21 completed renegotiations and 70+ total contracting efforts.
2. ASC Access and Rate Improvements: In Nevada, a decade-old ASC agreement was renegotiated, resulting in a 38% fee schedule increase and an estimated $23,000 annual revenue lift In Texas, two ASCs gained access to previously restricted payers—creating a projected 10+ additional patient referrals per month.
3. Annual Revenue Growth: $494,000 increase in 2024. $1 million annual lift on track for 2025.
4. Greater Internal Visibility: Team members now have real-time access to contracts, reimbursement terms, and credentialing statuses—supporting faster decisions and fewer operational delays.
5. Improved Collaboration: The relationship between internal stakeholders and the external contracting team functions as an integrated unit, driving sustained progress and shared accountability.

Conclusion

What began as a focused effort to stabilize clinic contracts evolved into a comprehensive strategy to support payer performance across the entire organization—including high-impact wins for ASCs. By combining structured prioritization, transparent collaboration, and payer-specific expertise, we’ve delivered measurable value while empowering internal teams to operate with greater clarity and confidence. With continued growth, this strong foundation positions our client to scale efficiently and strategically.