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How St. Charles Turned Clinical Quality into Payer Leverage: From Seven MA Payers to One
We dig into how St. Charles Health System, a four-hospital not-for-profit in Central Oregon and the sole major provider across a 32,000-square-mile service area, went from seven Medicare Advantage payers down to one and then turned a twenty-year track record of clinical quality into a negotiating tool that cut cancer treatment authorization times from weeks to a single day.
Matt Swafford, CFO, and Mark Hallett, Chief Clinical Officer, walk us through the decision to terminate contracts with six national MA payers, how they used NCCN concordance rates to negotiate instant authorization with…
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