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3 steps to profitable managed care contracts.

David B Wilson1, Michael Malloy, Jim McCoy

  • 1National Health Sciences Advisory Services, Ernst & Young LLP, Birmingham, Ala., USA. david.wilson@ey.com

Healthcare Financial Management : Journal of the Healthcare Financial Management Association
|May 28, 2004
PubMed
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Develop a robust managed care contract negotiation strategy by analyzing internal contract performance, comparing with competitors, and evaluating payer payment accuracy. This ensures optimal financial outcomes and contract terms.

Area of Science:

  • Healthcare Administration
  • Health Economics
  • Contract Management

Background:

  • Effective managed care contract negotiation is crucial for healthcare providers to ensure financial viability and operational efficiency.
  • Understanding the complexities of payer agreements and market dynamics is essential for successful contract outcomes.

Purpose of the Study:

  • To outline a comprehensive strategy for managed care contract negotiation.
  • To identify key analytical components for optimizing contract performance and financial returns.

Main Methods:

  • Conducting internal analysis of current managed care contracts, focusing on volume-discount rate and volume-profit relationships.
  • Performing external analysis by benchmarking against competitor contracts, prevailing market rates, and premium trends.

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  • Implementing payment performance analysis to assess payer promptness, accuracy, and associated penalties.

    • Main Results:

    • Internal analysis reveals discrepancies in volume-discount and volume-profit metrics across existing contracts.
    • External analysis highlights variations in market rates, contract language, and premium trends compared to competitors.
    • Payment performance analysis identifies specific payers with significant penalties due to delayed or inaccurate payments.

    Conclusions:

    • An effective managed care negotiation strategy requires a multi-faceted approach integrating internal, external, and payment performance analyses.
    • Data-driven insights from these analyses empower providers to negotiate more favorable contract terms and improve revenue cycle management.
    • Continuous monitoring and adaptation of negotiation strategies are vital in the evolving healthcare landscape.