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Related Experiment Videos

Conducting a managed care contract review.

T R Miller1, J E Belt

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

Healthcare Financial Management : Journal of the Healthcare Financial Management Association
|December 8, 1997
PubMed
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Healthcare providers must look beyond price in managed care contracts. A thorough business and legal review is crucial to understand and mitigate risks associated with contract terms and potential additional costs.

Area of Science:

  • Healthcare Administration
  • Contract Law
  • Risk Management

Background:

  • Managed care contracts are typically negotiated based on price.
  • Important contract terms beyond pricing can introduce significant legal, strategic, and financial risks for healthcare providers.

Purpose of the Study:

  • To highlight the importance of a comprehensive review of managed care contract terms.
  • To guide healthcare providers in identifying and mitigating potential risks beyond pricing.

Main Methods:

  • Review of traditional healthcare provider negotiation strategies.
  • Analysis of key contract clauses impacting provider risk.
  • Emphasis on dual legal and business review processes.

Main Results:

Related Experiment Videos

  • Contract terms significantly influence a provider's exposure to legal, strategic, and financial risks.
  • Clear definitions, dispute resolution clarity, and cost-implication assessments are vital.
  • Failure to scrutinize non-price terms can lead to unforeseen financial burdens.

Conclusions:

  • Healthcare providers need a holistic approach to managed care contract negotiation.
  • A thorough legal and business review is essential for risk mitigation.
  • Providers should be prepared to refuse unfavorable terms that may incur additional costs.