Jim helps healthcare providers optimize reimbursement from payers. His understanding of healthcare reimbursement methodologies—from fee-for-service to capitation—helps him identify appropriate payer contracting opportunities for his clients given their competitive positions, risk tolerance, strategic goals, and other attributes. Jim uses his analytical skills to quantify the opportunities, as well as his communication skills forged during his time as a healthcare marketing specialist to articulate the pros and cons to clients’ executives. He then negotiates with payers to achieve his clients’ contracting strategies. Thoughtful, responsive, and dedicated to his clients’ success, Jim understands the critical role payer contracting plays in a rapidly evolving healthcare landscape.
Jim has expertise in multiple functional areas related to payer contracting and managed care. He develops financial models for fee-for-service contracts and value-based reimbursement arrangements that help hospitals and physicians negotiate contracts with payers and enable accountable care organizations (ACOs) and clinically integrated networks (CINs) to reach decisions about reimbursement models, infrastructure needs, care models, and more. Jim also has extensive experience in ACO and CIN development and provides interim managed care support to hospitals and physician groups.
