This document summarizes a presentation on managed care contracting strategies for physician practices. The presentation covers: 1) Payer goals and how physician network participation impacts practices, 2) How patient steering works between payers, hospitals, and practices, and 3) Strategies practices can use to negotiate contracts and align with other providers. It discusses factors that influence referrals and revenues and challenges practices currently face in contracting with payers.
Health Insurance products can be challenging in today’s insurance environment. LionShare Insurance Group offers a complete line of individual health and life insurance products that are crafted to meet you and your family’s specific needs.
A combination of factors, including demographic changes, evolving consumer preferences, and regulatory and compliance mandates, were already spurring change in the health insurance industry. Enter 2020 and the COVID-19 pandemic, which is having sweeping implications for the industry.
At the peak of disruption, the focus was on ensuring business continuity, but new initiatives are cropping up to tackle the challenges as the industry adapts to the new normal.
Furthermore, some changes are here to stay, and it will be prudent for the industry players to be resilient to the market shifts by being agile, improving member centricity, making processes intelligent, and embracing the open ecosystem.
Read our Health Insurance Top Trends 2021 report to explore the strategies insurers are adopting to manage the external pressures.
Health Insurance products can be challenging in today’s insurance environment. LionShare Insurance Group offers a complete line of individual health and life insurance products that are crafted to meet you and your family’s specific needs.
A combination of factors, including demographic changes, evolving consumer preferences, and regulatory and compliance mandates, were already spurring change in the health insurance industry. Enter 2020 and the COVID-19 pandemic, which is having sweeping implications for the industry.
At the peak of disruption, the focus was on ensuring business continuity, but new initiatives are cropping up to tackle the challenges as the industry adapts to the new normal.
Furthermore, some changes are here to stay, and it will be prudent for the industry players to be resilient to the market shifts by being agile, improving member centricity, making processes intelligent, and embracing the open ecosystem.
Read our Health Insurance Top Trends 2021 report to explore the strategies insurers are adopting to manage the external pressures.
Value-Based Payments and Managed Care Contracting - Crash Course Webinar SeriesEpstein Becker Green
Epstein Becker Green Webinar with Attorney Basil Kim - Value-Based Payments Crash Course Webinar Series - May 31, 2016.
As value-based payment relationships continue to grow in prevalence and complexity, a question remains: How do I effectively capture this arrangement on paper?
Topics include:
* Some of the key strategic questions to deliberate with regard to contracting in a value-based payment relationship
* Considerations for contracting under a value-based payment framework.
http://www.ebglaw.com/events/value-based-payments-and-managed-care-contracting-value-based-payments-crash-course-webinar-series/
These materials have been provided for informational purposes only and are not intended and should not be construed to constitute legal advice. The content of these materials is copyrighted to Epstein Becker & Green, P.C. ATTORNEY ADVERTISING.
Risk-Based Contracting: Background, Assessment, and ImplementationPYA, P.C.
PYA Principal Bob Paskowski presented “Risk-Based Contracting: Assessments and Implementation,” at the National Association of Managed Care Physicians Fall Managed Care Forum, November 10-11, 2016. The presentation allows participants to:
Understand the different types and core elements of risk-based contracting (RBC).
Prepare for additional discussions with key stakeholders regarding RBC assessment and readiness.
Make informed decisions as to next steps while evaluating associated financial risks.
Public Media Development and Marketing Conference 2013 - Atlanta, GA Healthca...TW Integrated Marketing
Healthcare is one of public media's top-performing underwriting categories, but it's also greatly affected by shifting government regulations, changing economic conditions and consumer preferences. Gain critical insight into the US Healthcare market segment.
ISR interviewed 14 highly experienced decision-makers to better understand the Market Access function. These professionals shared their perspectives on a range of topics related to the Market Access function, including the role of Market Access within their organizations, the structure of the Market Access function, and the key challenges faced by Market Access. Where possible, ISR also collected information on departmental headcounts, budgets, and outsourcing volume.
The Evolving Role of the Compliance Officer in the Age of Accountable CarePYA, P.C.
Much has been written about new competencies physicians must develop in the face of payment and delivery system reform. But providers are not the only ones seeing their roles change. Compliance officers, who serve as organizations’ internal police officers, will have many new challenges. PYA Principal Martie Ross presented a national Health Care Compliance Association (HCCA) webinar entitled “The Evolving Role of the Compliance Officer In the Age of Accountable Care.”
Good Governance Practices for 501(c)(3) Organizations PYA, P.C.
PYA Tax Manager Elizabeth Wright presented “Good Governance Practices for 501(c)(3) Organizations” at the Accounting and Financial Women’s Alliance (AFWA) Luncheon in Knoxville, TN. The presentation provides an overview of good governance practices to assist any size 501(c)(3) organization in complying with IRS governance guidelines.
Value-Based Payments and Managed Care Contracting - Crash Course Webinar SeriesEpstein Becker Green
Epstein Becker Green Webinar with Attorney Basil Kim - Value-Based Payments Crash Course Webinar Series - May 31, 2016.
As value-based payment relationships continue to grow in prevalence and complexity, a question remains: How do I effectively capture this arrangement on paper?
Topics include:
* Some of the key strategic questions to deliberate with regard to contracting in a value-based payment relationship
* Considerations for contracting under a value-based payment framework.
http://www.ebglaw.com/events/value-based-payments-and-managed-care-contracting-value-based-payments-crash-course-webinar-series/
These materials have been provided for informational purposes only and are not intended and should not be construed to constitute legal advice. The content of these materials is copyrighted to Epstein Becker & Green, P.C. ATTORNEY ADVERTISING.
Risk-Based Contracting: Background, Assessment, and ImplementationPYA, P.C.
PYA Principal Bob Paskowski presented “Risk-Based Contracting: Assessments and Implementation,” at the National Association of Managed Care Physicians Fall Managed Care Forum, November 10-11, 2016. The presentation allows participants to:
Understand the different types and core elements of risk-based contracting (RBC).
Prepare for additional discussions with key stakeholders regarding RBC assessment and readiness.
Make informed decisions as to next steps while evaluating associated financial risks.
Public Media Development and Marketing Conference 2013 - Atlanta, GA Healthca...TW Integrated Marketing
Healthcare is one of public media's top-performing underwriting categories, but it's also greatly affected by shifting government regulations, changing economic conditions and consumer preferences. Gain critical insight into the US Healthcare market segment.
ISR interviewed 14 highly experienced decision-makers to better understand the Market Access function. These professionals shared their perspectives on a range of topics related to the Market Access function, including the role of Market Access within their organizations, the structure of the Market Access function, and the key challenges faced by Market Access. Where possible, ISR also collected information on departmental headcounts, budgets, and outsourcing volume.
The Evolving Role of the Compliance Officer in the Age of Accountable CarePYA, P.C.
Much has been written about new competencies physicians must develop in the face of payment and delivery system reform. But providers are not the only ones seeing their roles change. Compliance officers, who serve as organizations’ internal police officers, will have many new challenges. PYA Principal Martie Ross presented a national Health Care Compliance Association (HCCA) webinar entitled “The Evolving Role of the Compliance Officer In the Age of Accountable Care.”
Good Governance Practices for 501(c)(3) Organizations PYA, P.C.
PYA Tax Manager Elizabeth Wright presented “Good Governance Practices for 501(c)(3) Organizations” at the Accounting and Financial Women’s Alliance (AFWA) Luncheon in Knoxville, TN. The presentation provides an overview of good governance practices to assist any size 501(c)(3) organization in complying with IRS governance guidelines.
Claims Management - Edge through Efficiencyneetamundra
The objective of this paper is to talk about the current state of the claims process and how an efficient and ideal claims system should be. This document is most relevant for the Indian insurance industry.
How to Form and Operate a Network of Competing ProvidersPolsinelli PC
The Health Law Section of the Colorado Bar Association, together with the American Health Lawyers Association, hosted the 2nd Annual Colorado Health Law Symposium, a regional event co-sponsored by the nation's largest educational organization devoted to legal issues in the health industry. Mitchell Raup, Polsinelli Antitrust Shareholder presented How to Form and Operate a Network of Competing Providers at the symposium.
How Can You Aggressively Manage Benefits Affordability?Aggregage
https://www.compandbenefitstoday.com/frs/23543534/how-can-you-aggressively-manage-benefits-affordability-/email
Benefit cost increases regularly eclipse all other costs for organizations, yet bringing costs down is illusive. Now corporate priorities are swinging from solely a focus on talent to the need to actively manage benefit expenses, but no one wants to reduce benefits or ask employees to pay more.
Join two total rewards experts, Alex Anderson and Leo Tokar, for an in-depth discussion on tactics to efficiently and effectively control and manage benefit cost. This session will address critical questions such as:
• What are the driving factors driving cost increases?
• What are specific tactics that will allow you to control cost drivers?
• How do you manage costs not just for 1 year, but 3-5 years out?
• What are the tools you need to manage costs effectively?
Retail Distribution Review: Preparing Insurance IT for Compliance and Strateg...Cognizant
The Retail Distribution Review offers a significant compliance challenge for UK insurers and advisors. CIOs must prepare by ensuring they have the right enabling technologies to support changing distribution strategies.
Self Service Customer Care For Next Generation NetworksGreen Packet
Smartphone devices have dramatically changed the way consumers consume data. The need to be connected anywhere and anytime is driving service providers to put focus into customer experience to grow customers, build loyalty and drive profits through new services. As a result, the expectations of service experience from the end-user are heightened and cannot be underestimated.
Service providers are under pressure to deliver customer experience that separates them from the competition, while at the same time trying to delicately balance their revenues and managing costs for near term gain and longer term success. In this paper, we outline the scale of issues faced in mobile device and service care that impacts both service providers and end-users beyond connectivity. With a broad range of services and wide variety of applications, the smartphone requires more complexity to handle a multitude of firmware and software configurations which legacy CRM systems are inadequate to deal with today’s customers.
Remote device support and service care is a key component to tackle the demands of escalating costs in customer care. Service providers are seeking integration onto backend systems without incurring heavy infrastructure changes and ensure the best fit into the existing operations through automated and proactive customer care mechanisms to ensure service excellence and thus prevent service quality degradation.
From Complexity and Frustration to Simplicity and Effectiveness it is the most viable foundation for discovering new opportunities that build momentum and inspire growth.
1. 2010 Arizona HFMA Spring
Conference
(Chandler, AZ)
L E A D E R S H I P P R O B L E M SO L V I N G V A L U E C R E A T I O N March 18, 2010
Managed Care Contracting Strategy
and Emerging Business Models:
Physician Practice Perspective
Christopher J. Kalkhof, FACHE
Director, Healthcare Industry Group
(New York Office)
Copyright 2010. Alvarez & Marsal. All Rights Reserved.
2. Presentation Agenda
I. Payer Physician Networks
Basic Payer Goals
Participation vs. Non-Participation and Implications
for Practice
Payer Contracting Options and Products
Trends in Marketplace Impacting Practice Revenues
II. Patient Steerage – How Does it Really Work?
III. Managed Care Contracting Strategies and
Different Negotiating Techniques
Key Questions to Ask Before Signing Any Payer
Agreement
IV. Physician Alignment and Integration:
Evolving and Emerging Business Models
V. Questions & Answers
Copyright 2010. Alvarez & Marsal Holdings, LLC. All Rights Reserved. (1)
3. Presentation Agenda
I. Payer Physician Networks
Basic Payer Goals
Participation vs. Non-Participation and Implications
for Practice
Payer Contracting Options and Products
Trends in Marketplace Impacting Practice Revenues
II. Patient Steerage – How Does it Really Work?
III. Managed Care Contracting Strategies and
Different Negotiating Techniques
Key Questions to Ask Before Signing Any Payer
Agreement
IV. Physician Alignment and Integration:
Evolving and Emerging Business Models
V. Questions & Answers
Copyright 2010. Alvarez & Marsal Holdings, LLC. All Rights Reserved. (2)
16. Presentation Agenda
I. Payer Physician Networks
Basic Payer Goals
Participation vs. Non-Participation and Implications
for Practice
Payer Contracting Options and Products
Trends in Marketplace Impacting Practice Revenues
II. Patient Steerage – How Does it Really Work?
III. Managed Care Contracting Strategies and
Different Negotiating Techniques
Key Questions to Ask Before Signing Any Payer
Agreement
IV. Physician Alignment and Integration:
Evolving and Emerging Business Models
V. Questions & Answers
Copyright 2010. Alvarez & Marsal Holdings, LLC. All Rights Reserved. (15)
23. Presentation Agenda
I. Payer Physician Networks
Basic Payer Goals
Participation vs. Non-Participation and Implications
for Practice
Payer Contracting Options and Products
Trends in Marketplace Impacting Practice Revenues
II. Patient Steerage – How Does it Really Work?
III. Managed Care Contracting Strategies and
Different Negotiating Techniques
Key Questions to Ask Before Signing Any Payer
Agreement
IV. Physician Alignment and Integration:
Evolving and Emerging Business Models
V. Questions & Answers
Copyright 2010. Alvarez & Marsal Holdings, LLC. All Rights Reserved. (22)
31. Presentation Agenda
I. Payer Physician Networks
Basic Payer Goals
Participation vs. Non-Participation and Implications
for Practice
Payer Contracting Options and Products
Trends in Marketplace Impacting Practice Revenues
II. Patient Steerage – How Does it Really Work?
III. Managed Care Contracting Strategies and
Different Negotiating Techniques
Key Questions to Ask Before Signing Any Payer
Agreement
IV. Physician Alignment and Integration:
Evolving and Emerging Business Models
V. Questions & Answers
Copyright 2010. Alvarez & Marsal Holdings, LLC. All Rights Reserved. (30)
45. Presentation Agenda
I. Payer Physician Networks
Basic Payer Goals
Participation vs. Non-Participation and Implications
for Practice
Payer Contracting Options and Products
Trends in Marketplace Impacting Practice Revenues
II. Patient Steerage – How Does it Really Work?
III. Managed Care Contracting Strategies and
Different Negotiating Techniques
Key Questions to Ask Before Signing Any Payer
Agreement
IV. Physician Alignment and Integration:
Evolving and Emerging Business Models
V. Questions & Answers
Copyright 2010. Alvarez & Marsal Holdings, LLC. All Rights Reserved. (44)
47. The Alvarez &Marsal Advantage
Founded in 1983, Alvarez & Marsal (“A&M”) is a leading independent global professional services firm with more than 1,700 professionals
based in North America, Europe, Asia and Latin America.
Currently 39 offices globally with headquarters in New York, London, and Hong Kong.
Offer deep financial, tax, operational and industry expertise.
Deep bench of talent across industries with the unique ability to transition between financial, operational and advisory roles to meet client’s
changing business needs.
A&M is the leading, independent global professional services firm which excels at leadership, problem solving and value creation. A&M’s
Healthcare Industry Group practice represents an assembled team of healthcare professionals who bring a significant track record of working
with management, boards of directors and stakeholders of both investor-owned and non-profit providers, payers and suppliers to improve
operational, financial and clinical performance.
A&M’s managed care consultants and interim management professionals bring deep best practices expertise in the development of managed
care contracting and physician alignment strategies, payer contract negotiations, and the implementation / integration of contracting and
physician alignment strategies into an organization’s overall clinical and business operations.
Our managed care services are aligned with your contract management cycle and can be tailored to meet your specific needs and market
environment. We work with your team, serving in advisory or interim management roles, to ensure your success with your overall payer
contracting strategy.
www.alvarezandmarsal.com
Copyright 2010. Alvarez & Marsal Holdings, LLC. All Rights Reserved. 46
46