The situation
Like many health systems nationwide, our client—an academic medical center—was facing serious financial pressures in a post-pandemic economy. Rising drug and labor costs, supply chain challenges, and inflation were straining operations. These issues were intensified by outdated and unsustainable contracts with the system’s largest payors.
The challenge
The client had not renegotiated its contracts in several years but urgently needed updated rates and terms to reset its portfolio after years of inflation. They also required guidance on evaluating participation across commercial, Medicare Advantage (MA), and other insurance plans.
A particularly critical negotiation was initiated with the local Independent Blue plan, which held nearly 30% of the state’s market share.
Strategic approach
Unlock Health supported the client through a comprehensive negotiation strategy that combined ongoing counsel, message alignment, and targeted stakeholder communication. Deliverables included:
- Ongoing strategic counsel
- Strategy and message development
- Creation of letters for patients, employers, brokers, and hospital staff to inform them of the negotiation
- Leadership and physician talking points
- Media training
- Content for legislative discussions
- Board education and alignment
Results
3% above budget reimbursement rate increase since engagement, representing approximately $120 million in additional revenue over a three-year contract
Negotiated above-average reimbursement rates, exceeding initial expectations
Secured additional terms to reduce administrative burden
Successfully managed concurrent pressure from other payors
Developed a clearer, more strategic plan for Medicare Advantage and commercial participation