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Managed care consulting

Align payor strategy to financial reality

The right revenue strategy sets your organization up for success. We help you renegotiate or contract with the right payors, participate in the right networks, and secure the right terms — so you can protect your mission and goals in any market environment.

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Managed care consulting services we provide

Our work spans the full lifecycle of payor strategy and contracting:

  • Payor yield assessment and reimbursement benchmarking
  • Managed care contract review and optimization
  • Healthcare contract negotiation strategy and support
  • Payor performance analytics and reporting
  • Dispute readiness and scenario planning, including go-to market campaigns
  • Strategic communications for payor negotiations

How Unlock Health approaches managed care consulting

We don’t believe in generic playbooks. Every organization has a different market position, payor mix, and financial reality. Our approach combines data, strategy, and execution so you can make informed decisions.

Here’s how we do it:

Start with financial goals and payor performance

We begin by understanding how your current contracts are performing.

  • Analyze reimbursement rates across payors and service lines
  • Benchmark against market data and peer organizations
  • Identify underperforming contracts and revenue leakage
  • Evaluate payor mix and yield

This creates a clear picture of where you are today and where opportunities exist.

From there, we define a strategy based on your organization’s priorities.

  • Which payors and contracts matter most
  • Where renegotiation offers the greatest financial impact
  • How network participation aligns with growth and access goals
  • What success looks like across financial and operational metrics

This ensures your managed care strategy is proactive, not reactive.

We help you prepare for and execute high-stakes negotiations with confidence.

  • Develop negotiation positioning and messaging
  • Model financial scenarios and trade-offs
  • Identify leverage points and risk areas
  • Support leadership throughout the negotiation process

Our goal is to help you secure favorable reimbursement rates and contract terms that reflect the value you bring to your patients and community.

Not every negotiation goes smoothly. When disputes arise, preparation matters. Unlock Health works with you to:

  • Assess contract vulnerabilities and termination scenarios
  • Build data-backed arguments to support your position
  • Develop stakeholder and go-to market communication strategies
  • Support executive teams through public-facing situations

This is where strategy and communication come together and protect both your financial position and your reputation.

Managed care consulting is about building a sustainable model for negotiations.

  • Ongoing contract performance monitoring
  • Identification of new optimization opportunities
  • Alignment with service line growth strategies
  • Integration with broader financial and operational planning

We help ensure your contracts continue to support your organization as conditions change.

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FAQs

Do you support both commercial and government payor strategy?

Yes. We work across commercial, exchange, Medicaid, and Medicare Advantage contracts — including delegated risk and value-based models.

Absolutely. We assess performance, renegotiation timelines, and strategic alignment across your payor contract portfolio. This roadmap is essential for long-term planning and alignment with growth.

We’ve all been there. Our team includes strategists and communications experts who help you prepare for — and manage — public disputes. Our founder, Brandon Edwards, pioneered the use of strategic communications to help level the playing field against aggressive, all-powerful payors. These programs have evolved substantially since he pioneered this work back in 2002.

We work as an extension of your team, bringing outside perspective and tactical horsepower to the moments that matter most. Some organizations need partial- or full-outsourcing and we can meet those needs too.

All Capabilities

Let’s talk strategy.

Your next negotiation, dispute, or market move deserves more than a generic playbook. We’ll bring you data and insights, clarity, and confidence that your decision meets the needs of your community as well as your organization. Reach out and let’s start a conversation.

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