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Rating managed care plans as business partners
1Carolinas Hospital network, Charlotte, NC, USA.
Summary
Providers must evaluate managed care plans as business partners, not just for clinical quality. Developing specific performance indicators is crucial for assessing these partnerships effectively.
Area of Science:
- Healthcare Management
- Provider Relations
- Business Analytics
Background:
- Managed care plans face increasing consumer demand for quality care.
- Meeting consumer quality expectations does not guarantee provider satisfaction with business partnerships.
- A gap exists between consumer-focused quality metrics and provider needs for evaluating managed care organizations (MCOs).
Purpose of the Study:
- To advocate for the development of performance indicators for evaluating managed care plans as business partners.
- To guide providers in assessing the business aspects of managed care relationships beyond clinical quality.
Main Methods:
- The study proposes a framework for developing performance indicators.
- It outlines key areas for MCO evaluation from a provider's perspective.
Main Results:
- Providers require distinct metrics to assess MCO business performance.
- Key areas for evaluation include financial, administrative, and relational aspects of the MCO-provider partnership.
Conclusions:
- Clinical performance indicators alone are insufficient for evaluating managed care plans.
- Providers must develop and utilize comprehensive business partnership indicators to ensure mutually beneficial relationships with managed care plans.