Expanding ASC Access and Payer Contracting for a Growing Pain Management Group

Introduction

Over the course of five years, a fast-growing, multi-state pain management organization partnered with our team to strengthen its payer network participation, expand into new markets, and improve ASC reimbursement. What began as an engagement focused on clinic-level contracting evolved into a broader collaboration that included ambulatory surgery center (ASC) agreements, multi-state expansions, and support during periods of internal transition.

During this time, 81 contracts were successfully negotiated across multiple payer types and states—helping the organization secure rate increases of up to 180% of CMS for its ASC and expand its footprint across new markets including Colorado and Indiana. The partnership supported their ability to grow, integrate new entities, and build a more resilient revenue strategy.

Client Background

The client is a physician-led pain management group operating across Texas, Kentucky, Ohio, Colorado, and Indiana. The organization includes more than a dozen clinic locations and multiple ambulatory surgery centers offering interventional pain procedures and outpatient surgeries.

As the group expanded through acquisition and organic growth, leadership sought external expertise to manage payer strategy, credentialing, and network access across both their clinical and surgical operations.

The Challenge

1. Navigating Multi-State Growth: As the organization expanded across states and acquired new entities, managing a growing portfolio of payer relationships, contracts, and enrollment timelines became increasingly complex.
2. ASC Network Gaps: Several ambulatory surgery centers were not yet participating with key payers, limiting patient access and surgical throughput in certain markets.
3. Evolving Internal Structures: Ongoing organizational changes, including shifts in staffing and the realignment of internal responsibilities, required adaptability and strong coordination across stakeholders.
4. Balancing Workstreams: With both enrollment and contracting efforts underway, it became important to streamline priorities. In time, enrollment functions were brought back in-house, allowing external support to concentrate on payer strategy and negotiations.

The Approach

1. Strategic Payer Contracting: Efforts spanned both new network access and renegotiations, covering Commercial, Medicare, and Medicaid lines of business. Particular attention was given to aligning ASC contracts with priority payers and improving reimbursement structures.
2. Expansion Support: As new locations came online in states like Colorado and Indiana, contracting strategies were adapted to ensure timely payer engagement and continuity of care across new geographies.
3. ASC-Focused Contracting Improvements: Surgical centers received dedicated attention, with a goal of securing competitive rates and closing network gaps. New agreements ranged from 100% to 180% of CMS benchmarks, driving improved access and operational performance.
4. Collaborative Workflow: The work was carried out in close coordination with internal credentialing, compliance, and finance leaders—adjusting to evolving priorities while maintaining alignment on contracting goals.

The Results

1. 81 payer agreements successfully executed, including both new contracts and renegotiations across commercial and government lines of business.
2. ASC Rate Improvements: New ASC agreements yielded significant rate increases, ranging from 100% to 180% of CMS benchmarks—improving financial performance and payer alignment at the facility level.
3. Expanded Market and Payer Participation: The group extended its contracted footprint into new states, including Colorado and Indiana, and secured participation across a mix of Commercial, Medicare, and Medicaid payers, laying the foundation for continued growth.
4. Sustainable Infrastructure Amid Growth: Despite changes in staffing and internal structure, the organization maintained consistent progress on payer strategy and network expansion—supporting scalable growth across multiple entities and states.

Conclusion

Over five years, this collaboration helped lay the groundwork for payer success across both clinic and surgical operations. We delivered measurable value through expanded network access, stronger ASC reimbursement, and support during growth and transitions.