The situation
A multi-hospital regional system faced a commercial renewal with its largest payer. Leadership suspected its rates lagged the market and that underpayments were leaking revenue, but lacked the analytics to prove either. The renewal was months away and the internal team was stretched across day-to-day revenue-cycle work.
The problem wasn't the rate on paper — it was the gap between the contracted rate and what the system actually collected, which no one had quantified.
The approach
1. Realized-yield analysis
We measured what the payer actually paid, by service line, after denials, downgrades, and underpayments — separating the contracted rate from the collected rate.
2. Underpayment recovery
We identified patterns where the payer was not honoring contracted terms and built the documentation to recover them.
3. Market benchmarking
We benchmarked the system's rates against the market by service line to build a defensible renegotiation ask.
4. Data-backed renegotiation
We equipped the system's negotiators with the evidence to argue rate on value and market position, and to close the highest-exposure gaps first.
The result
| Lever | Illustrative contribution | How |
|---|---|---|
| Underpayment recovery | ~$1.6M | Recovered unpaid contracted amounts |
| Denial reduction | ~$1.1M | Root-cause fixes to recurring denials |
| Rate improvement | ~$2.2M | Market-benchmarked renegotiation |
| Total | ~$4.9M | Combined recovered and protected revenue |
Illustrative composite figures for demonstration; actual results vary by organization and are not a guarantee of outcome.
Beyond the dollars, the system left the engagement with a repeatable analytics capability and a sequenced plan for its remaining contracts.