Contracting in a Managed Care Environment PDF Download

Author: Robert Bonney
Publisher:
ISBN: 9781567931693
Category : Managed care plans (Medical care)
Languages : en
Pages : 0

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Book Description

Author: Maria K. Todd
Publisher: CRC Press
ISBN: 1439866570
Category : Business & Economics
Languages : en
Pages : 334

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Book Description
Managed care contracting is a process that frustrates even the best administrators. However, to ignore this complexity is to do so at your own expense. You don‘t necessarily need to bear the cost of overpriced legal advice, but you do need to know what questions to ask, what clauses to avoid, what contingencies to cover ... and when to ask a lawyer

Author: William A. Garofalo
Publisher: Jossey-Bass
ISBN: 9780787945817
Category : Health & Fitness
Languages : en
Pages : 0

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Book Description
Today's heath care marketplace is highly competitive, requiring managed care providers to contract with dozens of insurers to survive. Each of these contracts comes with their 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 chartsFor 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. "Managed Care Contracting is a very timely

Author: United States. Congress. House. Committee on Commerce. Subcommittee on Health and the Environment
Publisher:
ISBN:
Category : Business & Economics
Languages : en
Pages : 324

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Book Description

Author: Scott Becker
Publisher:
ISBN:
Category : Managed care plans (Medical care)
Languages : en
Pages : 420

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Book Description
Broad changes in the methods of paying for health care services have led to vast changes in the practice of medicine. This book provides the basic tools, including checklists, sample contracts, and key terms a physician needs to take charge of his or her future in the evolving health care system. It explains models and concepts that are available from market to market. More important, this book provides numerous tested strategies for responding to opportunities and the basic principles and means by which to judge situations and proposals. It will guide today's physicians through the managed care maze as they develop business plans and negotiate contracts. * Helps you take and maintain control over patient care by maximizing your autonomy. * Outlines differences in practice type and summarizes the pros and cons of your various options within the managed care environment. * Uses real-life examples throughout, discussing both successes and failures of other entrepreneurial physicians.

Author:
Publisher:
ISBN:
Category : Child health services
Languages : en
Pages : 88

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Author: Institute of Medicine
Publisher: National Academies Press
ISBN: 030906497X
Category : Medical
Languages : en
Pages : 304

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Book Description
America's Health Care Safety Net explains how competition and cost issues in today's health care marketplace are posing major challenges to continued access to care for America's poor and uninsured. At a time when policymakers and providers are urgently seeking guidance, the committee recommends concrete strategies for maintaining the viability of the safety netâ€"with innovative approaches to building public attention, developing better tools for tracking the problem, and designing effective interventions. This book examines the health care safety net from the perspectives of key providers and the populations they serve, including: Components of the safety netâ€"public hospitals, community clinics, local health departments, and federal and state programs. Mounting pressures on the systemâ€"rising numbers of uninsured patients, decline in Medicaid eligibility due to welfare reform, increasing health care access barriers for minority and immigrant populations, and more. Specific consequences for providers and their patients from the competitive, managed care environmentâ€"detailing the evolution and impact of Medicaid managed care. Key issues highlighted in four populationsâ€"children with special needs, people with serious mental illness, people with HIV/AIDS, and the homeless.

Author: Institute of Medicine
Publisher: National Academies Press
ISBN: 0309175054
Category : Medical
Languages : en
Pages : 394

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Book Description
Managed care has produced dramatic changes in the treatment of mental health and substance abuse problems, known as behavioral health. Managing Managed Care offers an urgently needed assessment of managed care for behavioral health and a framework for purchasing, delivering, and ensuring the quality of behavioral health care. It presents the first objective analysis of the powerful multimillion-dollar accreditation industry and the key accrediting organizations. Managing Managed Care draws evidence-based conclusions about the effectiveness of behavioral health treatments and makes recommendations that address consumer protections, quality improvements, structure and financing, roles of public and private participants, inclusion of special populations, and ethical issues. The volume discusses trends in managed behavioral health care, highlighting the emerging role of the purchaser. The committee explores problems of overlap and fragmentation in the delivery of behavioral health care and discusses the issue of access, a special concern when private systems are restricted and public systems overburdened. Highly applicable to the larger health care system, this volume will be of particular interest to all stakeholders in behavioral healthâ€"federal and state policymakers, public and private purchasers, health care providers and administrators, consumers and consumer advocates, accrediting organizations, and health services researchers.

Author: Maria K. Todd
Publisher: CRC Press
ISBN: 1040081118
Category : Business & Economics
Languages : en
Pages : 211

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Book Description
Managed care contracting is a process that frustrates even the best administrators. However, to ignore this complexity is to do so at your own expense. You don‘t necessarily need to bear the cost of overpriced legal advice, but you do need to know what questions to ask, what clauses to avoid, what contingencies to cover ... and when to ask a lawyer

Author: Joseph A. Welfeld, FACHE
Publisher: Jossey-Bass
ISBN: 9781556481567
Category : Health & Fitness
Languages : en
Pages : 0

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Book Description
From preparing for the shift to a managed care environment to negotiating the terms of managed care agreements, this executive briefing offers guidance for evaluating and negotiating with managed care organizations (MCOs) to create important strategic relationships--and details the steps necessary to execute a strategic approach to managed care contracting. The author describes the key performance indicators for evaluating an MCO and offers valuable insight into an MCO's contracting requirements and provider network strategy. Also outlined are the essential operational and functional components in managed care agreements and ways for the health care provider to control or limit risk. Additionally, Contracting with Managed Care Organizations provides a unique clause-by-clause comparison between an undesirable and a desirable hospital agreement with an MCO.