Related Experiment Videos
HMO performance assessment: group practice strategies and considerations
1Friendly Hills Health Care Network, La Habra, CA.
Managed Care Quarterly
|December 4, 1993
Summary
Evaluating health maintenance organization (HMO) contracts requires a structured approach. Separating contract evaluation into financial, administrative, marketing, and provider relations improves outcomes.
Area of Science:
- Healthcare Management
- Contract Analysis
- Provider Relations
Background:
- Evaluating Health Maintenance Organization (HMO) contracts presents significant complexities for providers.
- Existing evaluation frameworks often lack a comprehensive, multi-faceted approach.
Purpose of the Study:
- To delineate key areas for evaluating HMO contracts.
- To identify effective negotiation strategies for provider groups.
Main Methods:
- A conceptual framework is proposed, segmenting contract evaluation into four core domains: financial, administrative, marketing, and provider relationships.
- The study highlights the utility of team-based negotiation tactics.
Main Results:
- Contract evaluation is best managed by dissecting it into distinct financial, administrative, marketing, and provider relationship components.
- Team negotiation proves effective for managing complex elements like risk factors, reinsurance, pharmacy benefits, and nonfinancial contract terms.
Conclusions:
- A structured, domain-specific approach enhances the evaluation of HMO contracts.
- Collaborative, team-based negotiation strategies are crucial for optimizing contract terms and managing associated risks.