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An integrated approach to managed care contracting.

C Shapleigh1

  • 1Transition Systems, Inc., Boston, MA.

Healthcare Financial Management : Journal of the Healthcare Financial Management Association
|July 7, 1993
PubMed
Summary

Hospitals can improve managed care contract negotiations by using a six-step "closed loop" approach. This strategy integrates strategic, financial, and patient care processes for better risk management and opportunity maximization.

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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.

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