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MANAGED
CARE CONTRACTING:
STRATEGY, DESIGN, AND
IMPLEMENTATION
In our view, any
payer contracting strategy that relies on the reduction of managed care
in the future, is fundamentally flawed.
Accordingly, while
the future of some managed care entities is questionable, the future of
managed care itself is not; the alternative to managed care - unmanaged
care - simply has no future. Therefore, every medical practice, whether
independent or hospital-sponsored, needs to carefully review its
contracting strategy to determine the extent to which it is achieving
optimal results. In providing such support, Partners utilizes a
multi-step approach:
-
Build a "context" to include current contract inventory; reimbursement
levels, methods, and volumes; competitiveness of contracts relative to
the market; and financial performance of each contract (margin per
unit)
-
To
the extent required, educate stakeholders about managed care
contracting trends, key elements, landscapes, and alternative
strategies.
-
Create indicators to measure success including financial performance
targets, improved market position, and measurable incentives such as
improved patient satisfaction, level of risk to be managed, and the
amount of data collection required and by whom.
-
Review/determine key issues such as terms and conditions of each
contract; competitor comparisons (i.e., scope of services);
administrative, financial, and clinical issues, reimbursement level
and method; and incentives/withholds.
-
Evaluate internal capabilities to include current organizational
structure, leadership and management, information systems, provider
education, and capital/financial resources.
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Finalize contracting strategy by understanding/affirming its
goals/objectives to be achieved, timeline, "yes/no" thresholds, roles
and responsibilities, and leadership and management requirements.
Partners is available to assist with negotiations of contracts and any
implementation support required, including reaffirming infrastructure
requirements and developing appropriate monitoring processes and
reporting.
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