Managed Care Contracting Strategy

With the need for social distancing, one of the first potentially permanent changes in the delivery of health services was the introduction of telemedicine services. Our team will work with you to determine if your business is well positioned with each payer and define the steps needed to improve your relationships with payers. You will benefit from working with a team of professionals who have over 25 years of experience in contracting with managed care organizations, as well as an established reputation for fairness and professionalism across the industry. You benefit from whom and what we know. Accreditation is also an important part of the procurement department and network development team. SHC offers a comprehensive menu of certification services to all managed care providers, including hospitals, NFCs, physicians/clinicians, CSOs, psychiatric hospitals, qualified care facilities, and all ancillary providers. Inform clinicians of incentive coding requirements. Managed care workers should initiate these efforts by requiring health care plans to provide specifications for any quality measures used in contracts involving shared economies or risks. This information should include how measures are calculated, inclusions and exclusions of calculations, codes to be used, periods covered, and other data (see box on page 55). It is also important to obtain information about how and when medicare is authorized to update specifications. Healthcare organizations can use quantitative criteria to objectively identify their comparative desire to create value. Areas of preparedness include the level of coordination of team care, patient referral, physician engagement, and clinical and economic direction of service providers. Soundness of health information systems, network design, financial situation and relationship with health care plans; and operational efficiency.

Migration to price transparency and consumption (i.e. B comparative purchasing) was designed to reduce healthcare costs overall and for the consumer in particular. How do you see the impact on the future supply of cost drivers? The problem? MCOs want to get the most out of providers, which makes it necessary to implement a managed care contracting strategy. The COVID-19 pandemic has focused on telemedicine and other remote care services (e.B. medical homes and remote care management). Stakeholders predict that the widespread adoption of telemedicine and remote care services by patients and payers is now inevitable. Many payers were also more willing to reimburse telemedicine and remote care services. When providers consider asking payers to add telemedicine and remote care to their managed care contracts, they need to have a solid understanding of the economics of these services, including market prices for managed care reimbursement and typical provider margins. To successfully implement these alternative remote care services, providers should strategically transform their existing telemedicine and remote care capabilities into comprehensive virtual health workflows and engage and activate their patient base to take advantage of virtual health options. The public had more time to do some research. They plan online health services, have telemedicine visits, and pay online.

They want to know immediately if there is an epidemic somewhere. When it comes to the new benchmarks, many organizations are moving toward integrating Medicare reimbursement as a new benchmark comparison. By calculating each account with their attached payer and calculating the account using Medicare`s current methodology, you`ll get a better overview of operational performance using a Medicare comparison. Hospitals and all providers need to explore new revenue and contract models that may involve certain risks. A hospital can only cut so far, especially with lawyers who specialize in professional misconduct. John Collier brings over 25 years of experience in managed care contracting. With John`s unique insights, suppliers can create a level playing field by learning how to identify and avoid “landmines” designed by payers to take advantage of fewer suspicious suppliers. By combining the MCO`s knowledge of the profiling process with your strategic expectations of the negotiation process, you can create a relevant give-and-take strategy that will guide you through the negotiations and lead to limited concessions. Managed care workers should ensure that they identify all expenses associated with such requirements. Personnel, program development or redesign, training, procurement and deployment, financial analysis, and IT infrastructure certification costs can be significant and potentially offset revenue under the terms of the contract. If these characteristics are nascent or non-existent for the organization, the time it takes to achieve performance can also affect potential revenue, depending on the specified performance periods. .