20 factors to consider when negotiating a managed care contract

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.