Case Study: Rush Health models all commercial payer contracts and generates millions with PMMC

Rush Health Models All Commercial Payer Contracts and Generates Millions

Rush Health, a clinically integrated network in Chicago with four hospitals and over 130 physician practices, faced the challenge of accurately projecting reimbursement across a large volume of complex commercial payer contracts. To manage this, Rush Health has relied on PMMC’s contract modeling software since 2001 to capture, validate and analyze expected reimbursement and payer performance across its network.

Using PMMC’s contract modeling solution, Rush Health’s contracting team (five users) models roughly 100 proposals and counterproposals annually, uses payer scorecards to target opportunities, and negotiates every commercial contract based on the software’s outputs. PMMC’s tools run models in minutes for smaller payers and under 30 minutes for complex ones; Roy Caldarazzo reports the platform is their “source of truth” and believes the work has generated millions of dollars in the system while improving speed, confidence, and negotiation effectiveness.

Rush Health

Roy Caldarazzo

Associate VP, Contracting & Provider Services