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Taking control of managed care contracting.

S D Elliott

    Healthcare Financial Management : Journal of the Healthcare Financial Management Association
    |November 3, 1996
    PubMed
    Summary
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    Healthcare providers should thoroughly review managed care contracts to ensure long-term benefits. Careful examination of risk, reward, patient volume, pricing, and panel quality is crucial for sustainable partnerships.

    Area of Science:

    • Healthcare Administration
    • Health Economics

    Background:

    • Managed care organizations (MCOs) are increasingly prevalent in healthcare delivery.
    • Healthcare providers face complex contractual agreements when entering managed care arrangements.

    Purpose of the Study:

    • To guide healthcare providers in critically evaluating managed care contracts.
    • To identify key factors for assessing contract viability and sustainability.

    Main Methods:

    • Qualitative analysis of essential contract components.
    • Review of critical elements for provider assessment.

    Main Results:

    • Contracts require scrutiny of risk-sharing, patient care efficiencies, and patient volume.
    • Feasibility of pricing structures and quality of the physician panel are vital considerations.

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    Conclusions:

    • Thorough due diligence on managed care contracts is essential for provider success.
    • Understanding contract terms ensures beneficial and sustainable long-term healthcare partnerships.