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Negotiating successful managed care contracts.

B W Clark1

  • 1Dechert Price & Rhoads, Princeton, NJ, USA.

Healthcare Financial Management : Journal of the Healthcare Financial Management Association
|July 7, 1995
PubMed
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Managed care contracting aims for flexible treatment and payment frameworks. Generic contracts often fail; tailored agreements are essential for effective payer-provider collaboration in healthcare.

Area of Science:

  • Health Services Research
  • Healthcare Management
  • Contract Law

Background:

  • Managed care contracting is crucial for aligning healthcare treatment and payment.
  • Generic contracts often fail to meet the specific needs of payers and providers.
  • Achieving a cooperative and flexible contracting framework is a primary goal.

Purpose of the Study:

  • To identify key issues in managed care contracting.
  • To offer practical solutions for resolving common contracting challenges.
  • To promote more effective payer-provider agreements.

Main Methods:

  • Review of common managed care contracting practices.
  • Analysis of typical conflicts and challenges in payer-provider agreements.
  • Development of practical recommendations for contract negotiation.

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Main Results:

  • Generic contracts are often inadequate for managed care.
  • Key issues include lack of flexibility and provider-specific considerations.
  • Tailored contracts are more likely to achieve desired outcomes.

Conclusions:

  • Managed care contracting requires specific, adaptable frameworks.
  • Addressing unique payer and provider interests is vital for success.
  • Practical suggestions can improve the contracting process and outcomes.