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Related Experiment Videos

A managed care cycle provides contract oversight.

Paul B Stevenson1, Stephen F Messinger, Terri Welter

  • 1MedTactics, Arlington, Virginia, USA.

Healthcare Financial Management : Journal of the Healthcare Financial Management Association
|March 20, 2002
PubMed
Summary

Effective managed care contract management requires a systematic, ongoing cycle involving strategy, implementation, and performance monitoring. This structured approach by healthcare providers improves financial viability and ensures accurate payments.

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Area of Science:

  • Healthcare Administration
  • Health Services Management
  • Contract Management

Background:

  • Health plans' poor payment performance necessitates improved provider strategies.
  • Periodic management of managed care contracts is insufficient for optimal financial outcomes.

Purpose of the Study:

  • To outline an effective managed care cycle for providers.
  • To emphasize the need for systematic, ongoing contract management.
  • To improve provider financial viability through better contract oversight.

Main Methods:

  • Developing a comprehensive managed care cycle encompassing strategy, implementation, and monitoring.
  • Identifying specialized management tools, skills, and staff for each phase.
  • Involving diverse stakeholders, including the board, management, and finance staff.

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Main Results:

  • A structured managed care cycle enhances oversight and contract performance.
  • Specialized resources are crucial for effective contract management.
  • Broad organizational involvement is key to successful managed care strategies.

Conclusions:

  • Providers must adopt a systematic, ongoing approach to managed care contracts.
  • Implementing a robust managed care cycle increases the likelihood of accurate contracted payments.
  • Strategic management of managed care is vital for provider financial health.