Provider Services

Enterprise Strategy
Pricing Strategy Development
Payer Strategy Development
Payer Negotiation Strategy & Analytical Support
Innovative Payer Partnership Development
Managed Care Performance Transformation
Value-Based Strategy & Contracting Support

Payer Services

Provider Network Development & Management
Innovative Provider Partnership Development
Value-Based Program Strategy
Insurance Product Development

Guiding healthcare providers to optimal financial performance

We help healthcare providers develop payer strategies to optimize revenues in support of their core mission – delivering exceptional patient care.

Thriving in a Time of Change


The healthcare industry is constantly changing

We help clients navigate relationships with payers in evolving competitive landscapes and regulatory environments. Our team develops new strategies that enable revenue growth, unlock value and optimize performance.


Transparency creates opportunities and obstacles

As healthcare becomes increasingly consumer-focused and pricing grows more transparent, healthcare providers need tailored strategies to maintain their competitive edge.


Experience matters

Our team of experts, including many team members with executive leadership experience for payer and provider organizations, leverage industry experiences and analytic horsepower to deliver the best outcomes for our clients.

With increased competition and shifting market dynamics, Ridgeline Health Group helps position your organization for revenue growth.

The relationship between providers and payers is foundational for success and constantly evolving. Successful healthcare providers pursue new ways to position their organizations to offset compressing margins.

Our focus on the relationship between providers and payers enables us to help your organization navigate the challenges and uncertainty of these relationships. Our team offers a range of services, all aimed at driving the strategies you need to stay ahead of the competition.

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Our Services


Our extensive industry experience and data-driven consulting approach will help optimize your organization’s revenue and competitive positioning in your unique market environment.

Enterprise Strategy

Healthcare providers are increasingly confronted by a key strategic question—"do we need to transition various payer segments from our traditional fee-for-service business to a value-based care and reimbursement model (and, if so, how quickly)?”.

We draw upon our expertise and industry experience to guide providers in determining if, when, and how to approach this business model evolution. Our team will assess your market landscape, current capabilities and strategic priorities to determine the best long-term enterprise strategy for your organization.

Payer Strategy Development

As healthcare providers face rapid cost growth and increased pressure from price transparency, the need for a comprehensive payer strategy has never been greater.

Informed by national insights, we evaluate market and payer dynamics across various ‘purchaser segments’ including Employer-Sponsored, Individual, Medicare and Medicaid. We then develop the right enterprise payer strategy, segment-level payer strategies and approaches for each major health plan in your market with the goal of optimizing your market position and organization’s revenues.

Pricing Strategy Development

Pricing strategy has taken on a new level of importance in the age of federally mandated price transparency. A successful pricing strategy is built on your value proposition and optimizes your revenues over the short and long term by determining the right price for the services your organization delivers.

We help you understand your price position in the market and the ‘shop-ability’ of your services. Informed by your enterprise strategy, we can then develop the right pricing strategy to support your organization’s long term success.

Payer Negotiation Strategy & Analytical Support

Ridgeline Health Group is here to help whether you are looking for support on a major negotiation or to augment your managed care team on an interim basis.

Informed by market analysis, out-of-network scenario planning and contract modeling, our team has deep experience in developing effective negotiation strategies and successfully completing negotiations with all types of health plans across the country.

Innovative Payer Partnership Development

Growth is a challenge for many providers. Health systems have the opportunity to drive organic growth by partnering with payers to launch innovative insurance products anchored by their provider networks.

Ridgeline has extensive experience understanding the expected market of insurance product strategies, finding the right health plan partner and successfully launching the partnership. Further, we have helped organizations develop center of excellence programs for employers which have driven significant increases in commercial market share.

Managed Care Performance Transformation

Ridgeline can enhance the performance of your managed care function. Drawing upon best-in-class processes, tools and frameworks, we are able to efficiently assess the performance of your organization’s managed care function and identify and execute on priority opportunities to elevate performance.

During times of transition, we can support your organization with our bench of experienced professionals in a variety of roles.

Value-Based Strategy & Contracting Support

Amidst continued pressure on fee-for-service rates, the healthcare industry is continuing to expand value-based care and contracting efforts. As healthcare providers approach this transition, the first step is understanding your organization’s level of readiness to assume risk for episodes or on a per capita basis for various populations by assessing capabilities and current strategic plans.

Informed by these capabilities, we then develop the right multi-year value-based strategy for your organization, appropriate negotiation guardrails and often provide support to value-based negotiations. Further, we often leverage our deep experience in designing and optimizing provider networks to help accelerate performance in value-based arrangements.

Historical approaches to managing relationships with payers no longer yield the same results. Whether you are looking to develop a comprehensive payer strategy, for help enhancing the performance of your managed care team or for support on a high-stakes negotiation, Ridgeline Health Group has the expertise to support you.

We know the pressures that healthcare providers are facing today and we are happy to help.

Executing Significant Network Expansion for National Health Plan

A national health plan focused on the Medicaid segment was interested in growing its presence in a southeastern state. See how Ridgeline helped them in this expansion.

Our People Are...


Our team combines deep provider and payer industry experience with an analytically rigorous approach to work. We understand the intricacies of relationships between providers and payers. We are here to guide you to the best path forward.

Provider Insights

How to develop a winning pricing strategy in the post-Covid-19 consumer market

Healthcare is on the verge of a new era of price transparency driven by CMS requirements and organizations leveraging this newly available information.

Continue Reading

Lead your organization with confidence, no matter what comes your way.

Tell us your goals.
Share your organization's current situation and objectives in managing provider-payer relationships.
Develop your strategy.
Our nationally recognized industry experts will create a tailored strategy and execution plan to help you overcome challenges you face along the way.
Enjoy continued success.
Position your organization for continued success in a rapidly evolving healthcare landscape.