Managed care consulting
Align payor strategy with financial performance
Managed care contracts are one of the biggest drivers of financial performance for hospitals, health systems, and provider groups. Yet too often, payor relationships are managed reactively instead of strategically. This limits reimbursement, increases risk, and makes long-term planning harder than it should be.
A strong revenue strategy starts with the right payor contracts. Through our managed care consulting services, we help our clients:
- Establish the right data-driven and growth-oriented strategy
- Renegotiate or contract with the right payors
- Participate in the right networks
- Secure the right terms that support their financial goals, not the payor’s
We we work with
We partner with a range of healthcare organizations for managed care consulting, including hospitals and health systems, academic medical centers, physician enterprises and provider groups, and ancillary providers.
Each organization faces different challenges, but the need is the same: stronger alignment between payor strategy and financial performance.
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.
Build a payor contracting strategy aligned to your goals
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.
Support negotiation strategy and execution
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.
Prepare for disputes and high-risk scenarios with health insurance payors
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.
Align contracts to long-term performance
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.
What outcomes can you expect from managed care consulting?
The impact goes beyond contracts. Our clients typically see improvements in:
- Net patient revenue and reimbursement rates
- Payor mix and contract performance
- Visibility into financial drivers and risks
- Negotiation confidence and positioning
- Alignment between finance, operations, and strategy
Most importantly, they gain the ability to make proactive, informed decisions about how they engage with payors.
Frequently asked questions about our managed care consulting services
What is managed care consulting and why is it needed?
Managed care consulting focuses on how healthcare organizations structure and manage relationships with insurance payors. This includes contract negotiations, reimbursement rates, network participation, and performance requirements.
Our view at Unlock Health is that managed care consulting is more critical than ever. We believe this because of what we see happening across the board:
- Payors are applying increasing pressure on reimbursement rates
- Contract terms are becoming more complex and harder to manage
- Margin compression is forcing organizations to rethink legacy agreements
- Network decisions directly impact patient access and volume
- Administrative burden continues to mount
Without a clear strategy, many providers are:
- Underpaid relative to market benchmarks
- Locked into unfavorable contract terms
- Reacting to payor demands instead of shaping them
A strong managed care consulting strategy ensures your contracts reflect the true value of the care you provide to patients, your cost structure, and growth priorities. A strategy built this way means you can support your mission in any market environment.
Do you support both commercial and government payor strategy?
Yes. We work across commercial, health exchange, Medicaid, and Medicare Advantage contracts including delegated risk and value-based models.
Can Unlock lead a full payor portfolio review?
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.
What happens if a payor negotiation turns hostile or public?
We’ve got your back. Our team includes strategists and communications experts who help you prepare for and managed public disputes. Our founder, Brandon Edwards, pioneered the use of strategic communications to help level the playing field against aggressive, all-powerful health insurance payors.
Learn more about our strategic communications offering.
Do you replace internal managed care teams?
We work as an extension of your team, bringing outside perspective and tactical horsepower to the moments that matter most. Some healthcare organizations need partial or full outsourcing. We can meet those needs too.
Let's build a smarter managed care strategy
Managed care contracts are too important to manage reactively. If you’re evaluating your current contracts, preparing for negotiations, or navigating a dispute, we help you move forward with confidence.