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Achieving incremental volume increases.

J E Belt1

  • 1Jennings Ryan & Kolb, Atlanta, GA, USA.

Healthcare Financial Management : Journal of the Healthcare Financial Management Association
|March 8, 1997
PubMed
Summary

Managed care contracts can increase patient volume, but success requires specific contract provisions. Providers should negotiate terms like discounts and network limitations to ensure higher patient numbers.

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Area of Science:

  • Health Services Research
  • Healthcare Management
  • Contract Negotiation

Background:

  • Managed care organizations (MCOs) aim to control healthcare costs and utilization.
  • Provider assumptions of increased patient volume from managed care contracts are not always met.
  • Effective contract negotiation is crucial for realizing mutual benefits.

Purpose of the Study:

  • To identify key contract provisions that enhance patient volume for healthcare providers.
  • To explore strategies for improving the success of managed care contracts.
  • To understand the factors influencing the provider-MCO relationship.

Main Methods:

  • Analysis of contract provisions within managed care agreements.
  • Review of factors influencing patient volume in provider networks.
  • Qualitative assessment of negotiation dynamics between providers and MCOs.

Main Results:

  • Specific contract clauses, including volume-based discounts and network restrictions, correlate with increased patient volume.
  • Patient financial incentives and provider directory accuracy are significant factors.
  • Successful negotiation leads to improved provider-MCO relationships and mutual understanding.

Conclusions:

  • Providers can proactively influence patient volume by strategically negotiating managed care contract terms.
  • Collaboration on contract provisions fosters stronger, more successful partnerships between providers and MCOs.
  • Addressing contract details is essential for maximizing the benefits of managed care arrangements.

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