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Managed Care Contract Negotiations Morph Under PPACA

Greg Freeman, April 23, 2014

Negotiating a managed care contract is not the same as it was even a few years ago. Now all of the power providers have in managed care negotiations is in their ability to prove that they can manage quality and cost more effectively than the next guy, says one expert.

This article appears in the April 2014 issue of Managed Care Contracting and Reimbursement Advisor.

Negotiating a managed care contract is not the same as it was even a few years ago. The changing healthcare landscape has produced a number of new considerations and twists on the familiar issues.

The Patient Protection and Affordable Care Act and the move toward accountable care has put a much greater emphasis on quality measures than in previous years, says Greg Chittim, a senior healthcare IT consultant at Arcadia Healthcare Solutions in Burlington, Mass. All of the power providers have in managed care negotiations is in their ability to prove that they can manage quality and cost more effectively than the next guy, he says.

That proof is best provided with a comprehensive set of quality measures reported directly from the electronic health record. This can be straightforward for a single practice using the basic reporting functionality of its EHR, but a number of factors can make the endeavor more complex. For example, a managed care plan might require nonstandard measures that the EHR vendor can't or doesn't want to develop. Trouble also can arise when the provider has multiple EHR vendors in the network and needs a single, apples-to-apples measurement across the network.

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