As the recognized leader in the field of direct contracting, A.J. Lester & Associates, Inc. has saved its employer clients millions in health plan costs without short-changing medical providers. By carefully analyzing client needs and daring to think outside-the-box, we create unique client solutions through a wide range of specialized consulting strategies for employers and medical providers.We also provide consulting services to consultants, brokers, and TPAs.
We help self-insured employers reduce medical plan costs and problems by eliminating the managed care middleman. By negotiating direct "win-win" agreements between employers and medical providers, we create direct provider networks that the employer can count on to provide affordable, high-quality medical care to employees and their dependents.. More...
As a pioneer and leader in the field of direct managed care contracting, A.J. Lester & Associates offers hospitals, physician groups, healthcare systems, ACOs, and other medical providers professional consultation on designing, developing, negotiating, implementing, and managing direct agreements with employers in their communities. More...
A.J. Lester & Associates, Inc. can develop direct networks in locations where commercial managed care networks are not fulfilling the clients' needs for access, savings, or service. This helps solidify the client relationship so consultants, brokers, and TPAs give clients what they need. More...
Services for EmployersServices
A.J. Lester & Associates, Inc. helps self-insured employers reduce medical plan costs and problems by eliminating the managed care middleman. By negotiating direct "win-win" agreements between employers and medical providers, we create direct provider networks that the employer controls. In each case, the employer-owned network facilitates better access to providers; saves claim dollars; reduces service problems; and improves employee satisfaction.
Whether your company's employees are concentrated in a few metropolitan areas or are spread throughout many small to mid-sized towns and rural areas across dozens of states, direct managed care contracting may provide the solution you're looking for.
Top eight reasons to use direct managed care contracting:
Services for Brokers, Consultants, & TPA'sServices
As health plan costs continue to surge, direct provider contracting is a valuable strategy for brokers, consultants, and third party administrators (TPAs) to recommend to clients for reducing costs and improving service. A.J. Lester & Associates, Inc. can develop direct networks in locations where commercial networks are not fulfilling the clients' needs for access, savings, or service.
Our strategies solidify the client relationship so brokers, consultants, and TPAs give clients what they need. It also helps defend the predatory practices of managed care companies and carriers of taking business away with promises of better networks or greater savings.
Frequently asked questions about direct provider contracting:
Services for Medical ProvidersServices
The cold, hard reality for doctors and hospitals is that commercial managed care companies still control the means by which medical providers do business with employers. In the process, providers have been forced to accept adversarial contracts, dwindling reimbursements, and greater practice restrictions. Cutting out the middleman and contracting directly with employers is a viable alternative that every medical provider should consider.
As a pioneer and leader in the field of direct managed care contracting, A.J. Lester & Associates, Inc. offers physicians, hospitals, health systems, ACOs, and other medical providers expert consultation on developing direct agreements with employers in their communities.
We offer medical providers the following consulting services:
Review and evaluate existing marketing efforts to determine new opportunities for direct contracting.
Analyze current managed care contract participation in HMOs, PPOs, and other third party payor networks.
Analyze contractual and reimbursement terms of existing commercial managed care contracts, assessing the value of each contract to provider.
Analyze new and renewal managed care agreements solicited by HMOs, PPOs, and other managed care vendors. Recommend proper course of action (accept, reject, negotiate, etc.).
Identify potential contractual and market obstacles to direct contracting. Recommend actions to overcome them.
Develop strategies and action plans for implementation of direct provider agreements and integrated marketing plans.
Develop all contractual and reimbursement tools specific to providers' needs.
Identify and contact local self-funded employers to introduce provider's desire for direct contracting.
Represent provider in negotiation of direct agreement with employer, including all initiatives related to value-based care, population health, and shared-savings.