Managed Care Contracting: A Practical Guide for Health Care Executives

by Garofalo, William A.; Horowitz, Eve T.; Reardon, Thomas M.

• ISBN13: 9780787945817
• ISBN10: 0787945811
• Format: Hardcover
• Copyright: 1999-01-01
• Publisher: John Wiley & Sons Inc

Summary

Today2s heath care marketplace is highly competitive, requiring managed care providers to contract with dozens of insurers to survive. Each of these contracts comes with their its unique terms and conditions-making the contracting process overwhelmingly complex and giving many health care executives major headaches.Written by three of the country2s leading health care consultants and attorneys, Managed Care Contracting is the first book to offer executives with no legal background practical, step-by-step advice on how to create winning contracts between health care organizations, payers, and employers. In straightforward language, free of legalese and jargon, this much-needed resource demystifies managed care contracting and prescribes some critical advice for hospital and physician group practice executives.The authors present helpful guidelines for evaluating the various types of managed care contracts and explain the most significant terms and concepts executives are likely to encounter. A treasure trove of information for health care executives no matter what their experience level, Managed Care Contracting Examines how to develop a contracting strategy Reviews the fundamentals of negotiating the contract Frames the key steps in the contracting process Provides a managed care contract negotiations checklist Dissects sample hospital and physician contracts Analyzes the contract risk factors by the type of payment explores the implications of changing financial incentives Outlines the most up-to-date information in the regulatory environment Includes illustrative examples and helpful tables and chartsFor health care executives who are just beginning the complex contracting process and for the more experienced who require the most current information on the topic, Managed Care Contracting provides the knowledge and tools they need to succeed. "Managed Care Contracting is a very timely

Table of Contents

Foreword	ix	(2)
Norman C. Payson, M.D.
Preface	xi	(4)
The Authors	xv
Introduction	1	(7)
1 Planning for Managed Care Risk Contracting	8	(12)
2 Developing a Contracting Strategy	20	(5)
3 Evaluating a Proposal	25	(23)
4 Negotiating the Contract	48	(8)
5 Sample Hospital Contract	56	(20)
6 Sample Physician Contract	76	(21)
7 Managed Care Operations	97	(9)
8 Conclusion	106	(3)
Index	109