Publisher's Synopsis
Today′s health care marketplace is highly competitive, requiring managed care providers to contract with dozens of insurers to survive. Each of these contracts comes with its unique terms and conditions–making the contracting process overwhelmingly complex and giving many health care executives major headaches.
Written by three of the country′s leading health care consultants and attorneys, Managed Care Contracting is the first book to offer executives with no legal background practical, step–by–step advice on how to create winning contracts between health care organizations, payers, and employers. In straightforward language, free of legalese and jargon, this much–needed resource demystifies managed care contracting and prescribes some critical advice for hospital and physician group practice executives.
The authors present helpful guidelines for evaluating the various types of managed care contracts and explain the most significant terms and concepts executives are likely to encounter. A treasure trove of information for health care executives no matter what their experience level, Managed Care Contracting
⋅ Examines how to develop a contracting strategy
⋅ Reviews the fundamentals of negotiating the contract
⋅ Frames the key steps in the contracting process
⋅ Provides a managed care contract negotiations checklist
⋅ Dissects sample hospital and physician contracts
⋅ Analyzes the contract risk factors by the type of payment
⋅ Explores the implications of changing financial incentives
⋅ Outlines the most up–to–date information in the regulatory environment
⋅ Includes illustrative examples and helpful tables and charts
For health care executives who are just beginning the complex contracting process and for the more experienced who require the most current information on the topic, Managed Care Contracting provides the knowledge and tools they need to succeed.
Step–by–Step Guidelines for Creating Successful Managed Care Contracts
"Managed Care Contracting is a very timely book by some true experts in the field. This book is an indispensable guide to contracting from all perspectives. It couldn′t have come at a better time as we all grapple with the rapid evolution of managed care."––Jay M. Gellert, president and CEO, Foundation Health Systems, Inc.
"This book will be a valuable resource for physicians and hospitals as they embark upon risk contracting relationships. Providers need to have a clear understanding of the potential pitfalls that lie along the road of contract negotiations. Managed Care Contracting outlines those aspects of contracting that should be of greatest concern to providers over the long term. Providers will be well–served by reading, learning, and incorporating the principles outlined in this book."––Ellen Zane, network president, Partners HealthCare System, Inc.
"With the advent of Physician Hospital Organizations (PHOs), and their appetite for accepting medical risk transfer from managed care organizations, it is essential for PHO managers to understand what they have accepted. These new organizations must build the administrative infrastructure to manage the risk they have assumed. Managed Care Contracting will help further the knowledge of these managers, while also providing building blocks for success."––Robert Campbell, executive vice–president, Family Health Plan, Inc.
"Contracting with managed care organizations is an essential survival skill in modern medicine, yet few health care professionals acquired the necessary tools as part of their professional preparation. While it used to be sufficient just to be professionally outstanding, it is now also necessary to negotiate one′s opportunities with wisdom and skill. Without that skill, professional training and talent are at risk of sitting idle on the sideline. Managed Care Contracting, authored by experienced experts, will help to fill a void."––Kenneth E. Quickel, Jr., president, Joslin Diabetes Center
