An integrated approach to managed care contracting

Area of Science:

• Healthcare Administration
• Health Information Systems

Background:

• Managed care plans represent a growing segment of hospital revenue.
• Effective negotiation of managed care contracts is crucial for hospital financial health.

Purpose of the Study:

• To present a structured, six-step
• closed loop
• approach for managed care contracting.
• To demonstrate how hospitals can leverage information systems to integrate key processes within the managed care cycle.

Main Methods:

• A systematic, six-step framework for managed care contracting is detailed.
• Emphasis is placed on the integration of strategic, financial, and patient care processes.

Main Results:

• The proposed approach facilitates a comprehensive management of the managed care cycle.
• Integration through information systems allows for better alignment of hospital operations with contract terms.

Conclusions:

• Implementing a closed-loop, information-system-integrated approach can optimize managed care contract outcomes for hospitals.
• This strategy aids in minimizing financial risk and maximizing opportunities within managed care arrangements.