Debbie Ryan

Debbie’s primary responsibility with KaufmanHall is third party contract review, CINs and PHOs.  There are still a lot of charge based third party contracts around the country.  Payors are not set up to handle VPB or outcome based contracts and they are outsourcing processing of these services rather than investing in technology to bring the technology in-house.  Physicians and health systems are experiencing difficulty managing VBP arrangements.  insurers are becoming more aggressive in their contracting due to pressure from employers to keep prices down.  Payors referencing their provider manual in contracts taking a lot of leverage from providers. Members are experiencing difficulty with payors recouping payments from as much as four years ago.  Anthen is causing a lot of difficulty with MRI, CT and ER diversion tactics.