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Managed care contracting 101


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Managed care contracting 101

  1. 1. Managed Care Contracting 101 Building Your Contracting Business Plan
  2. 2. The Business Plan <ul><li>Conduct internal assessment </li></ul><ul><ul><li>Begin assessment at least 8 months prior to contract end/renewal date </li></ul></ul><ul><ul><li>Review historical business volume among various payer or provider clients </li></ul></ul><ul><ul><li>Evaluate current contract performance gaps </li></ul></ul><ul><ul><li>Solicit internal stakeholder input </li></ul></ul><ul><ul><li>Establish desired objectives under new contract </li></ul></ul><ul><ul><li>Have financial team prepare pro-forma with future performance goals </li></ul></ul>
  3. 3. The Business Plan Continued <ul><li>Assess current external business environment </li></ul><ul><ul><li>Inventory competitors, market share, best practices, short-comings </li></ul></ul><ul><ul><li>Make best estimate of provider/payer business conditions </li></ul></ul><ul><ul><li>Review governmental and regulatory conditions, current and projected </li></ul></ul><ul><ul><li>Determine implications for your business </li></ul></ul>
  4. 4. The Business Plan Continued <ul><li>Prepare a contracting calendar </li></ul><ul><ul><li>Prioritize projects by business volume/need for new contract </li></ul></ul><ul><ul><li>Establish timeline for negotiations </li></ul></ul><ul><ul><li>Set start date, milestones and end date </li></ul></ul><ul><ul><li>Communicate timeline with internal stakeholders </li></ul></ul><ul><ul><li>Record and communicate progress, barriers, action plans and resolution steps </li></ul></ul>
  5. 5. The Business Plan Continued <ul><li>Contract negotiations process </li></ul><ul><ul><li>Conduct up kick-off meeting with client </li></ul></ul><ul><ul><li>Share performance outcomes and objectives under new contract terms among parties </li></ul></ul><ul><ul><li>Come prepared with business volume metrics </li></ul></ul><ul><ul><li>Schedule follow-up meetings/feedback frequency </li></ul></ul><ul><ul><li>Meet timelines for all parties and address issues promptly </li></ul></ul><ul><ul><li>Ensure contract terms can be administered by all parties </li></ul></ul>
  6. 6. The Business Plan Continued <ul><li>Post Negotiation Steps </li></ul><ul><ul><li>Communicate results with internal stakeholders </li></ul></ul><ul><ul><li>Conduct informational meetings/distribute communication vehicle across organization </li></ul></ul><ul><ul><li>Develop contract performance monitoring process </li></ul></ul><ul><ul><ul><li>Set up database retrieval format for monitoring </li></ul></ul></ul><ul><ul><ul><li>Evaluate performance at least quarterly </li></ul></ul></ul><ul><ul><ul><li>Investigate gaps between actual and desired performance; make corrections as necessary </li></ul></ul></ul>
  7. 7. The Business Plan <ul><li>Important Tips! </li></ul><ul><ul><li>Treat parties as business associates not adversaries </li></ul></ul><ul><ul><li>Start negotiations early and communicate often </li></ul></ul><ul><ul><li>Hold periodic meetings with client to ascertain issues and maintain favorable relationship </li></ul></ul><ul><ul><li>Keep diary of meetings, follow-up actions and commitments </li></ul></ul><ul><ul><li>Make sure contract terms can be administered </li></ul></ul>