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HMO performance assessment: group practice strategies and considerations.

A E Barnett¹, T Mayer

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.

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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.

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