When a midsize community health system sought to expand its footprint in a growing service area, it engaged PYA to assist with its strategic decision-making process. The resulting case study, Using Claims Data to Support Strategic Decisions, describes how PYA used its proprietary analytics tools with the system’s claims data to help the client assess the financial impacts of expanding its facilities to an off-site location.
PYA analyzed the reimbursement implications associated with shifting services from the hospital to the proposed new facility. Specifically, PYA’s focus was to help the organization understand expected reimbursement for services provided at an off-campus, free-standing ambulatory surgery center (ASC) or a micro-hospital. PYA’s analysis used historical claims data and related assumptions regarding the scope of services to be provided at the new facility.
Combining the results of the analysis and years of industry experience, PYA helped the client in several ways:
- Understand service volumes
- Understand service reimbursement by site of service
- Understand backfill opportunities at the main hospital campus
Additionally, when a negative reimbursement impact was predicted, PYA helped the client strategize options to meet its financial needs while providing care to its community.
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Read these related articles on strategies to optimize revenue streams during managed care contracting:
Comprehensive Payer Scorecard and Relativity Analysis for Managed Care Contracting
Analysis to Understand the True Economics of a Proposed Payer Reimbursement Agreement
PYA leverages our expertise and proprietary healthcare analytics tools to help organizations navigate complex strategic decisions with confidence, ensuring their choices align with their financial objectives and the evolving needs of their communities. If you are considering expanding your service offerings and seek to elicit valuable information from your claims data to inform your strategic decision-making, our executives are happy to help.
