Managed Care Contracting – Faqs From The Provider Point Of View

The latest and most effective development that the healthcare industry has witnessed in recent times has been the concept of managed care. This system has allowed numerous people to access high end treatments and medical facilities while ensuring that the service providers also get their due. But with increased popularity comes unprecedented confusion as well, making it difficult for medical institutions who are looking to make the right choices both financially as well as medically. In this article I have tried to answer the many burning questions that seem to haunt the minds of healthcare service providers with regards to managed care contracting.

Q#1: How many employees should you have to be eligible to negotiate managed care contracts?

Ans: There is no preset regulation about the number of people working as your employees to be able to enter into managed care contracting. The truth however is that doctors generally prefer larger organisations to smaller healthcare providers because of the obvious advantages of scale, better management and larger reach to patients. But that is again, just a business practice. If you feel you can negotiate well and convince medical professionals to get on board your managed care programs, by all means go ahead!

Q#2: Which system has a greater liability on the service provider – direct contracting or going through managed care companies?

Ans: Both systems of managed care contracting offer similar exposure to litigation and providing you manage the associated risks well enough, chances are you won’t face any issues. All you need to do is hire a trustworthy consulting firm to help formulate a strategy with enough failsafe measures in place to ensure effective avoidance of undue losses and you are good to go.

Q#3: How to negotiate a good deal with doctors and medical personnel?

Ans: There is no ‘one correct answer’ here. Whether you are looking to strike a deal directly with the doctor or are going through the safer route of hiring managed care companies to do the job, the only principle I would suggest will be to stick to your gut feel . But remember to disclose all the aspects of the contract to the doctor you are dealing with. The managed care industry has taken on a bad reputation due to the unscrupulous acts of some entities forcing adversarial agreements and poor reimbursements upon doctors. This refreshing change to honesty and straightforwardness might just be the edge you need to close the deal.

Q#4: How will you be able to contain costs in managed care contracting?

Ans: Some say the expertise of managed care companies is necessary to save employers from undue losses in the industry. Others feel that these issues can be managed in direct contracting as well. Good planning, well informed decisions and sound risk management will help you achieve the goals you are setting out to get.

If you are looking for more information on managed care contracting, be sure to visit the website

About The Author

Megan Ryan is an expert in the field of managed care who offers her knowledge and expertise in the form of the articles and blogs she writes on the topic. She recommends as the most trusted provider of managed care consult in the US.

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