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Related Experiment Videos

Legal considerations in managed care contracting

W J Miller1

  • 1Weissburg and Aronson Inc., Los Angeles.

Topics in Health Care Financing
|January 1, 1993
PubMed
Summary

Managed health care contracts, often seen as fixed, involve negotiable terms like definitions, pay, and termination. Due diligence and antitrust compliance are crucial when providers negotiate agreements.

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Area of Science:

  • Health care administration
  • Contract law

Background:

  • Managed health care systems rely heavily on contractual agreements.
  • Contracts with managed care organizations are frequently perceived as non-negotiable by providers.

Purpose of the Study:

  • To identify and discuss key negotiable terms within managed care contracts.
  • To highlight the importance of precontracting due diligence and antitrust compliance.

Main Methods:

  • Analysis of common contract terms in managed health care.
  • Review of legal and business considerations in contract negotiation.

Main Results:

  • Key negotiable contract elements include definitions, compensation, term, termination, and boilerplate provisions.
  • Precontracting due diligence and adherence to antitrust laws are essential for providers.

Conclusions:

  • Providers can and should negotiate core terms in managed care contracts.
  • Strategic negotiation and legal compliance are vital for successful managed care contracting.

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