Case Study

A Multi-State Behavioral Health Provider Advances Growth With Data-Driven Payer Negotiation Strategy

A multi-state behavioral health provider operates a growing network of substance use disorder treatment facilities across the midwest. As payer pressure increased and growth expectations intensified, the organization needed a more reliable way to understand reimbursement dynamics across markets and competitors.

By implementing Trek Health’s Price Intelligence solution, the organization replaced anecdotal assumptions with validated market data, allowing leadership to pursue expansion and negotiations with greater confidence and precision.

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Impact

Generated $4.1M+ in incremental commercial revenue tied to renegotiated contracts.

Expansion Confidence‍

  • Validated reimbursement feasibility for new-state expansion before committing capital
  • Replaced Medicare-based assumptions with market-specific benchmarks

Operational Efficiency

  • Eliminated weeks of manual contract diligence
  • Enabled rapid response when payer data was needed urgently

Before Trek Health’s transparency data, expansion and negotiations relied too heavily on assumptions. Now, every discussion starts with what the market is actually paying, and that has fundamentally changed how we grow and negotiate.

—

Senior Managed Care Executive

Challenge

Before adopting a Transparency in Coverage (TiC) solution, the organization faced several structural challenges.

  • Expansion decisions relied on incomplete assumptions, often using Medicare proxies or peer anecdotes to model reimbursement in new states.
  • Negotiations lacked proof, forcing the team to assert underpayment without payer-specific, competitor-backed evidence.
  • Contract validation was inefficient and unreliable. Outdated contracts, missing amendments, and manual diligence slowed decision-making.

Solution

The organization adopted a data-driven approach to its managed care strategy, replacing assumptions with defensible market realities.

Payer and competitor-specific reimbursement benchmarks were used to evaluate new market expansion before committing resources, allowing leadership to model expected revenue with confidence rather than relying on Medicare proxies or anecdotal input. This made transparency data the catalyst for expansion decisions instead of a post hoc validation tool.

At the same time, the organization fundamentally changed its approach to payer negotiations. By entering discussions with clear evidence of what competitors were being paid by the same payers in the same markets, negotiations shifted from subjective claims of underpayment to fact-based conversations that required payer accountability.

Finally, the organization gained speed and accuracy at critical decision points by eliminating reliance on outdated contracts and manual diligence. Immediate access to current market rates, saved reports, and repeatable analyses enabled teams to move quickly while maintaining confidence that decisions were grounded in reliable, up-to-date data.

Looking Ahead

The organization plans to continue embedding transparency insights into all commercial negotiations and future market evaluations.

As growth continues, leadership is exploring broader use of competitive benchmarking and contract intelligence to further align expansion strategy, payer performance, and margin protection.