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Hospital managed care performance standards.

T Peck¹, D N Schopp, D G Foshage

¹Daughters of Charity National Health System, St. Louis, MO.

Managed Care Quarterly

|December 4, 1993

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Hospitals must proactively develop managed care strategies and performance standards. Failing to do so leads to a reactive stance, limiting influence over this crucial payer segment.

Area of Science:

Healthcare Management
Health Services Research
Hospital Administration

Background:

Managed care is a critical component of healthcare financing.
Hospitals face increasing pressure from various payer segments.
Proactive engagement in managed care is essential for financial stability.

Purpose of the Study:

To emphasize the importance of establishing proactive managed care strategies for hospitals.
To highlight the risks associated with a reactive approach to managed care contracting.
To underscore the opportunity for hospitals to influence managed care payor dynamics.

Main Methods:

This study is a conceptual analysis based on healthcare management principles.
It reviews the strategic implications of managed care for hospital operations.

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Expert opinion and industry best practices are synthesized.

Main Results:

Hospitals that fail to set their own managed care direction and performance standards adopt a reactive posture.
This reactive position diminishes a hospital's ability to influence managed care contracting.
Managed care represents a significant opportunity for hospitals to shape their financial future.

Conclusions:

Hospitals must take a strategic, proactive approach to managed care.
Establishing clear contracting performance standards is crucial for maintaining control.
Active management of managed care relationships is vital for hospital success and sustainability.