Provider Network

Get better contract terms and a return on your investment – with less effort.
Network providers have received $1 million in value-based payments since 2020.

Access to more payers – giving you access to more potential clients and better occupancy.

• Includes more payer networks, as network health plans often prefer larger networks versus single facility contracts
• Provides better contract terms due to expertise of professional network staff

Value-based payments – giving you a return on your investment

• Offers value-based payments to participating providers and access to contracts that recognize quality and better outcomes that individual providers cannot be a part of due to volume

Administrative/credentialing support – saving you valuable staff time

• Reduces administrative costs for documentation collection and submission to multiple health plans
• Monitors contract terms and notices from payers that may try to amend contracts or require other action to stay in network

Support for claims, revenue cycle and systemic payer issues – with less hassle for you

• Identifies and solves systemic claims issues
• Reduces cost of claim issue resolution
• Provides a process and relationship with payers for escalating and resolving claims issues, helping network members collect over $1.25 million in unpaid and/or underpaid claims from insurance plans

Strategy and understanding – from network staff who are experts at reviewing health care contracts

• Long-term care legal expertise
• Provides expert review of contracts from network staff who understand long-term care, saving you legal fees

Exclusive consulting and education – giving you the competitive edge on quality

• Access to exclusive quality consulting that includes process and system reviews to help you meet quality goals and metrics, with particular attention paid to specific contracted rehospitalization and infection control goals
  • IHCA’s expert consultant works with providers to formulate action plans and assist with implementation 
• Offers exclusive and specialized quality education and clinical consulting, customized to members’ specific needs

IHCQP offers you two tier options to choose from based on your organization’s specific needs.

Tier 1: Contract Support With the Messenger Model (Non-Price Terms Only)

In Tier 1, provider network members receive support to approach payers for joint contracting non-price terms. This is known as the messenger model, in which the appointed messenger (the IHCQP network) obtains information on proposed fees and fee-related terms from a payer. Then, the messenger provides that information to each of the providers separately, seeking their individual decision to accept or decline the offer.

Tier 1 services also include: 

• Credentialing
• Contract management
• Contract negotiation of non-price terms
• Payment resolution to contract
• Quality measurement and focus
• Quality consultation and education

Tier 2: Full-Service Contract Support With Clinical and Financially Integrated Model (Price Terms Included, Plus Quality Incentive Payout Option)

In Tier 2, network providers receive all of the benefits of Tier 1, PLUS they are able to add clinical and financial integration. This gives them the added benefits of negotiation for better contract rates and a return on their investment with a quality benchmark and investment (or quality incentive payout). This tier also includes a financial investment, quality measurement and benchmarking, implementing consistent evidence-based care paths, measuring adherence to care paths and risk sharing with MCO partners.

Tier 2 includes services provided in Tier 1, as well as:

• Quality benchmarks and investment
• Negotiation of contract rates

IHCQP has more negotiating power than other networks because it is able to communicate the quality of its network to payers. This is possible because IHCQP members measure their quality. IHCQP providers define their own set of quality measures, agree to measure, create benchmarks and aggregate existing CMS data in order to present timely, accurate quality data to payers and improve contracting options.

Examples of quality measures determined by IHCQP providers include:

• Rehospitalizations/emergency room/observation stays
• Hospitalizations following discharge from a skilled nursing facility
• Five-Star Quality Measures
  • Pressure ulcers
  • Falls with major injury
  • Immunizations

“Balancing a facility operation is a challenge. IHCQP has given us the ability to credential and negotiate contracts to be able to provide care for our consumer, with access to more insurance contracts than some small operators were previously able to attain. The network also acts as a resource by providing and hosting quality focused initiatives to not only improve care for our residents but also to achieve reimbursement outcomes commensurate with the care we provide.”

– Tom Swanson, Administrator, Maple Heights
Skilled nursing and home health care provider

“As a member of the IHCQP, I have a dedicated team of staff reviewing insurance contracts for best terms and quality incentives. I have tried to negotiate with an insurance company in the past, and due to my facility’s small number of beds and lives, it was not possible. If you are looking for a great return on investment – this is it.”

– Maureen Cahill, Administrator, Spurgeon Manor
Skilled nursing and assisted living provider

There are limited spots available. To learn more or to participate, contact Brandon Hagen, SVP, Reimbursement and Policy Advisor, at 515-978-2204.

Organizations must be a member in good standing of the Iowa Health Care Association (IHCA).