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20 factors to consider when negotiating a managed care contract

G M White1

  • 1Mid-America Cardiology Associates, Kansas City, Missouri, USA.

Missouri Medicine
|July 1, 1996
PubMed
Summary

This guide offers a 20-factor checklist for negotiating managed care contracts. Understanding contract terms is crucial for healthcare practices facing increasing plan negotiations and evolving patient choice landscapes.

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Area of Science:

  • Healthcare Administration
  • Health Policy

Background:

  • Managed care contracts are increasingly complex.
  • Healthcare practices face extensive negotiations with various insurance plans.
  • Patient choice is diminishing due to plans like Medicare HMO Risk.

Purpose of the Study:

  • To provide a comprehensive checklist for negotiating managed care contracts.
  • To emphasize the importance of contractual terms beyond just financial aspects.
  • To equip healthcare practices with knowledge for effective managed care negotiations.

Main Methods:

  • Development of a 20-factor checklist for contract negotiation.
  • Analysis of key elements in managed care agreements.
  • Review of the impact of Medicare HMO Risk plans on practice negotiations.

Main Results:

  • Identified 20 critical factors for consideration during contract negotiation.
  • Highlighted that contractual terms are as vital as capitation rates or fee schedules.
  • Emphasized the necessity for practices to master managed care negotiation intricacies.

Conclusions:

  • Healthcare practices must prioritize understanding and negotiating all aspects of managed care contracts.
  • A thorough checklist aids in navigating complex healthcare agreements.
  • Knowledge of negotiation strategies is essential for practice viability in the current healthcare environment.

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