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Managed Care Contracting and Network Development Consultants


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  • 1. HCPC consultants represent Managed Care Organizations across the country in recruitment andcontract negotiations with health care providers. We specialize in Medicaid, Medicare Advantage,SNP, LTC, Commercial managed care contracting and reimbursement methodologies.We Get it Done! Reduce your development time by 40% by using our proven processHealthcare Provider Connections utilizes industry leading CRM tools that track real time providerresponse to your contract. Reporting can be customized and changed to fit any organizations needs.Whether the company is small, medium or large, we can help you grow and increase membership bybuilding a strong network of quality health care professionals.Consultants at Healthcare Provider Connections have several years of experience working withinmanaged care plans. Our company has a successful track record negotiating rates and contractlanguage with hospitals, physician groups, and ancillary providers across the countryHCPC has a proven development system that allows us to contract with hundreds of providers withina short time frame. We collaborate with key decision makers in the provider communities to meet orexceed your contracting goals.Our Network Development services include:•Initial market research•Identify and educate potential providers on your product•Negotiate managed care fee schedules and contract language•Collect LOI’s, LOA’s, and agreements from interested providers within any specified GSA•Create HSD tables for CMS•Write narrative and exception letters for CMSHealthcare Provider Connections identifies and aligns resources to meet departmental objectivesand coordinates those resources to ensure the successful delivery of contracts.
  • 2. Provider Education & Orientation Provider Outreach StrategicManaged Care Market Contracting Analysis Network Development
  • 3. HCPC Contracting Approach Provider Outreach, Email/Mail Education, Contracts Orientation HCPC Virtual and InCreate Strong Contracting PersonRelationships Approach Meetings Social Media Strategic Market Networking Analysis
  • 4. The True Cost of an Employee….Hourly rate – This one is easy. For this example, let’s use $75,000 per year as a pay rate, which equates toslightly more than $36 per hour for 2,080 hours per year. One key difference with contractors is you onlypay for productive hours. Full-time employees are paid during non-productive hours, such as vacation,holidays and sick time.Statutory costs – Social Security and Medicare cost employers 7.65% of a base salary plus federal andstate unemployment insurance. For a $75,000 employee, this equates to more than $3 per productive hourworked.Employee benefits – Full-family benefits such as health care costs, which rise each year, and 401kmatching can equate to $8 per productive hour worked.Training costs – The actual amount per employee depends on the type of job and varies from company tocompany. It is estimated that the cost per hour worked ranges from $0.50 to $2.50. Using contractors orconsultants allows you to avoid paying for training courses, conferences, subscriptions and certifications.Training time – Contractors and consultants are paid for hours worked. Companies pay only for the valuecreated and not when a contractor is focused on non-productive tasks. Five days of training per yearequates to nearly $2,000 in lost productivity for an employee making $75,000. As such, use of a contractorabates approximately $1 per hour of training expense.
  • 5. Vacation time – Like training, vacation cost is abated by using contractors. Depending on your time-off policy, youcan avoid two to three weeks of cost. Two weeks of vacation equates to $4,000 per year for an employee making$75,000 or approximately $2 per productive hour. In addition, paid breaks can amount to an additional two to fourhours per week.Paid holidays – Most companies offer approximately ten days of paid holiday time, equating to $4,000 per year or$2 per hour.Sick time – Depending on your policy, you may avoid the cost of between 5 and 10 sick and/or personal days. Thisequates to $2,000 to $4,000 per year or $1 to $2 dollars per productive hour worked.Bad hire costs - Bad hires are expensive. Studies indicate that the cost of a bad hire is two and a half to threetimes the employee’s salary. This cost is avoided with contractors, who can be terminated with little headache ifthings don’t work out. If one in thirty hires is a bad one, then we should increase the hourly rate by 10% perproductive hour work.Hiring costs – Hiring is an expensive process. Significant management time is invested in gathering resumes,screening resumes, making calls to candidates, testing, scheduling interviews, conducting interviews, evaluating andchoosing a candidate, negotiating the offer, and repeating the process if the candidate does not accept. These costscan be reduced by using contractors. This management and human resources time can be focused in areas ofgreater value to the business. For the purposes of this example, I’ve included no allocation for hiring costs.Separation costs – The unfortunate situation where you choose to terminate an employee creates costs for thecompany. If the employee is laid off, severance costs are avoided. If the termination is performance-based, all of thetime invested by HR and management on counseling, deliberations and termination are avoided. While incurringthese costs are not certain, by using contractors you avoid this risk. For the purposes of this example, I’ve includedno allocation for separation costs.For a $75,000 resource, hard costs equate to approximately $22 per productive hour worked or nearly$40,000 per year!
  • 6. Who do you want representing your company? HCPC COMPETITOR Real Job Advertisement Real Job AdvertisementHiring- Managed Care Contracting Consultants – MUST have at We are seeking qualified candidates for roles as Networkleast 5+ years working in a managed care health plan in Network Development Specialists:Development and/or Provider Relations negotiating Medicaid,Medicare Advantage, Long Term Care , and Commercial Network Development Specialists - entry level recruiters:contracts. Contract negotiation and or mediation experience helpful. TheExperience: To be considered you must have at least 5+ verifiable right candidates will engage in one on one telephone calls withyears successfully building managed care networks for Medicare targeted providers to achieve agreement within expeditedAdvantage and/or Medicaid health plans. Candidate must have timeframes, be successful at creating quick dynamicrecent experience contracting with hospitals, ancillary relationships, be quick on your feet to convert and closecompanies, IPAs, PHOs, multispecialty physician groups, and agreements, maintain high quality data and pipeline detailsLong Term Care providers according to proven processes.Education: Bachelors degree required, MBA or MHA preferred, Skills: Bachelor’s degree with health care or sales experienceMust have excellent MS Office Suite skills and attend on going preferred; Minimum of 1 year health care experience; familiarityeducation and training with Medicare and Medicaid is helpful, some understanding ofJob Description: Must have a home office, high speed internet payor reimbursement methodologies, ability to negotiateand be available for travel. Work from home most of the time effectively and collaboratively, familiarity with provider relationscontacting required providers, track daily recruitment status and network development processes is helpful, critical thinkingusing our customized web based CRM. Build relationships and skills and intermediate skills in Microsoft Word and Exceltrust with providers and collect their agreements and necessary.credentialing items within a set deadline.Requirements: Clean MV record, valid license, pass criminalcheck and drug screen. Annual compliance training and testing
  • 7. Who do you want representing your company? HCPC Competitor • Hires Professional Contracting • Hires temp workers with little to no Consultants with at least 5+ years managed care contracting experience contracting for a payor. • All consultants must pass a rigorous • Interviews and hires over the phone with no screening process including extensive known screening or background checks interviews, criminal background and drug screening • Has consultants based across the • Has a call center where there is a high country with established provider turnover relationships in their service delivery area • Builds Marketable Provider Networks in • Often fails to accomplish contracting goals 60-90 days. Often hired when competing for projects lasting 5-6 months companies fail to complete the network • Provide our clients with productivity • No accountability for how time and your reports so you know what the money is spent. consultants accomplished each day • Our consultants are available on short • Often agree to provide experienced term notice. They can jump right in and consultants then scramble to find anyone get the job done available to work in their call center
  • 8. “Healthcare Provider Connections did a great job by quickly garnering effectivecontracting resources to help us build out provider networks for our Medicare AdvantagePlan.”-Arcadian Health Plan“As a repeat customer for almost two years now, Healthcare Provider Connections is thefirst company we go to for consulting purposes and we keep several of herrepresentatives almost year round. Her billing is timely and very easy to read andunderstand. We also receive a breakdown of the work and progress of each consultant foreach week which is very helpful to us.”-Aetna Medicaid“Heather and her team of seasoned Medicaid Contracting Consultants were brought in andimmediately hit the ground running. HCPC consultants were able to successfullynegotiate agreements with hundreds of PCPs and Specialists in multiple counties over avery quick 60 day window to help IlliniCare meet its access requirements.My colleagues and I were extremely impressed by the experience, knowledge and resultswe saw from HCPC and would not hesitate to hire them again as the opportunity arises.’’- Centene Corporation