UNC Health modernizes its managed care contracting strategy with Turquoise

The problem

UNC Health is one of North Carolina's largest health systems, operating 20 hospitals, eight ambulatory surgery centers, roughly 3,500 employed physicians, multiple ancillary ventures, and hundreds of locations serving rural and urban communities across the state. Scott Trott, System Vice President of Managed Care, has led managed care contracting for the system for over a decade. His payer contracting and analytics team of 25 handles every payer negotiation and contract renewal across all of those entities.

Since 2023, payer renewals have become more contentious and more public than at any point in Trott's 30-year career. UNC Health went briefly out-of-network with a large national payer in early 2024 and nearly did so again with a different payer at the end of 2025. These two situations raised the level of awareness of both the public and UNC Health coworkers regarding the vital role contract renewals play in a health system’s fight to remain financially viable. Rural communities across North Carolina depend on UNC Health for access to care. When a renewal goes wrong, people don’t just feel it, they have no choice but to live it.

"Our decisions now impact literally hundreds of thousands of people. We have to be very precise, defensible, and we have to do a whole lot of planning to ensure success." —Scott Trott, System Vice President of Managed Care, UNC Health

As the system grew, the tech the team used to manage contracts had not kept pace. A few years ago, a single major renewal involved thousands of pages of documentation pulled from dozens of separate contracts across multiple acquired entities. They all had different rate exhibits, different terms, and different conditions. Assembling those documents essentially became a months-long, full-time job for multiple team members before actual negotiations could begin.

Their workload was rife with challenges: Basic questions from leadership could take half a day at best, days at worst to accurately and confidently answer. The team was fully-remote in a post pandemic work world, which made the old approach of walking to a contract file room impossible. And on the analytics side, Director of Managed Care Analytics, Erin Grigg, had her team building detailed rate models for every cycle exclusively using internal data. Sure, they knew what UNC Health was paid. But they had no way of knowing what payers were paying competitor providers. When price transparency files became publicly available, the team tried to mine them directly. Files were terabytes large. Formats changed year-to-year. They didn’t have the resources.

"It's really hard to determine win-win scenarios when you don't know what you look like compared to your peers," said Grigg. "We knew what we needed in aggregate, but we didn't know where there was room to push or where we were already high in the market."

Payers began arriving at the negotiating table with price transparency data of their own, citing specific service lines where they believed UNC Health was out of market. The team had no reliable way to verify or counter those claims.

UNC Health negotiates from a position of knowledge with Turquoise Health

UNC Health had been aware of Turquoise since the early days of price transparency. After completing a major renewal cycle, Trott decided to explore how Turquoise could support his department. During the call, one of Trott's colleagues texted him: the platform had their exact contracted rate on screen. "We didn't give it to them," said Trott. "They're able to get to this level of detail." For Trott, that precision was the signal he needed. “Turquoise offered a platform that solved almost all of our problems,” he said. “It created a stable place for our contracts to live, a stable place to access and answer questions, and a stable place to research our own positioning."

Within days of signing, Trott was pulled into an unscheduled meeting with senior financial leaders looking to see the platform in action. Two days into his first-ever Analyze login, he built a graph comparing UNC Health rates against competitors in their core market and presented it live. "I still have senior financial leaders that bring up that meeting and are continuing to ask, 'What more do you have there?' We were able to answer questions and help guide discussions at a speed we hadn't been able to before." said Trott.

The team now uses the platform across several areas

Diligence and decision-making

‍After the contracting team spent hours analyzing a policy objection and a payer's proposed resolution, Stephanie Hanscom, Director of Managed Care Contracts, used AskTQ to generate a risk analysis summary of whether to accept the deal. It came back in seconds with a structured summary covering trade-offs, risks, and the exact questions leadership was likely to raise.

"Some of those exact questions that AskTQ raised were the ones leadership would have asked. So we had the answers ready." —Stephanie Hanscom, Director of Managed Care Contracts.

It came back in seconds: a structured summary covering trade-offs, risks, and the exact questions leadership was likely to raise.

"Some of these exact questions that AskTQ raised were the ones leadership would have asked. So we had the answers ready," said Hanscom. Leadership accepted the recommendation and the meeting was much shorter than historically needed, without any need for a second meeting, due to the comprehensive nature of the assessment. The outcome saved the organization approximately $2 million.

In a subsequent major renewal, a payer arrived citing price transparency data to argue that UNC Health's rates were too high in specific service lines. The team used Turquoise to verify the payer's position, disputed claims based on methodological differences, and provided counter-examples backed by data. "That was kind of an aha moment. This type of data is going to be a really important part of future renewals for us." said Trott.

Competitive rate analysis

‍Erin Grigg's team uses Analyze before entering any major negotiation. Clear Rates helps them validate whether hospital-reported and payer-reported rates align, and which data carries the most certainty. They can now compare hospitals across service lines and markets, identify where UNC Health is likely to face pushback, and structure proposals around a clear view of where there is room to move.

Contract comparison and decision support

‍When two health plans announced a merger that would create a single unified contract, a single contracting team member used AskTQ to compare both agreements, generate a same-day structured summary of key terms, and land on a recommendation of which contract was stronger in each area. A decision that would previously have taken at least two weeks was resolved in a day.

Policy impact analysis

‍When a payer releases an updated reimbursement policy, Director of Managed Care Contracts Stephanie Hanscom and Managed Care Senior Analyst Donald Gemmel used the platform to respond to payer policy changes. When a payer releases an updated reimbursement policy, they now use AskTQ to surface relevant contract language across all affected entities, saving their team of analysts from manually locating and reviewing applicable contracts. For a system with the entity diversity of UNC Health, that kind of speed matters. "Payer policies can impact tens of millions of dollars on an annual basis," said Gemmel. "Being able to respond in real time helps us deliver analysis to our contract team in order to either launch objections or find a net revenue neutral position."

The outcome

The UNC Health team has built the Turquoise Health platform into daily workflows across a team of 25. The next major renewal cycle is on the horizon and Trott expects to enter it with competitive rate intelligence, considerations already analyzed, contract language reviewd, and proposals built around a clear strategy by service line and market, a level of preparation that simply wasn't possible before.

"I'm confident that we can do it all again. But I'm also confident because we're going to have the ability to both defend and advocate for what it is we need going forward." —Scott Trott, System Vice President of Managed Care, UNC Health