The Art of Disintermediation:
Direct with Employer Contracting®
A MASTER CLASS with Maria Todd
Author, The Managed Care Contracting Handbook, 2nd edition
Upcoming Master Class Dates
LOCATION: Denver, Colorado
DATES: October 24-25, 2016
Hyatt Place Denver Downtown
440 14th Street, Denver, CO 80202
HOTEL DISCOUNTS: Hyatt Place Downtown Denver 440 14th Street, Denver, CO 80202
(Our 15% discount includes mini suite, hot breakfast each morning, free Wi-Fi)
DRESS CODE: Very Casual - Be Comfortable!
WHAT TO BRING: A laptop computer that can edit MS Word® and Excel documents. All course materials supplied on a USB drive.
In The Art of Disintermediation: Direct with Employer Contracting®, you’ll learn innovative ways to contract directly with employers, unions and state-owned institutions.
Preparation is important. Maria Todd has been teaching the public and in-house customized preparation for contracting in her award winning signature workshops and seminars on Analyzing Managed Care Agreements for over 23 years to help participants achieve higher and more accurate reimbursements with fewer administrative hassles. In that class, participants come away with tools to help them plan more effectively and how to come up with mutually rewarding relationships between payers and providers. They bring home extensive take home materials for future reference and to speed up the analytical process.
But direct contract catches many hospitals, ASCs, and other healthcare providers unprepared. First, they don't have a draft contract agreement to offer that's "on their paper". That requires skills that many people lack. You can use a checklist or template, but you must also know what the customer wants and doesn't want, and why they are eager to disintermediate (contract directly with providers) from their current managed care or PPO network. And these are some of the timely tips and techniques Maria shares with you in this Master Class on The Art of Disintermediation: Direct with Employer Contracting®.
Maria will supply Master Class participants with an actual contact template that has been used by corporate buyers in hundreds of deals she's structured over the past 15 years. The template alone will save you, on average, 5x the price admission on legal drafting fees, even if you just checked in, collected course materials and headed back to your office. But there's so much more value to this class.
What employers want from healthcare providers - that they aren't getting from HMOs, PPOs and ASOs
Employers want providers that deliver truly better health outcomes at lower cost. They don't care if you are located across the street, in another state, another country, downtown Baltimore or downtown Cleveland. If you've got a deal that gives them what they want, they'll listen. They also want reasonable prices, less over-treatment, bundled case rates, and fair business dealings. Many healthcare organizations promise value but few deliver it packaged in a contract that is ready to be signed, sealed and delivered. According to a recent article in Modern Healthcare, "direct contracting has gotten media attention lately, the term doesn’t adequately convey the depth of purchasers’ senses of frustration with and betrayal by the healthcare industry. Benefits managers’ and CFOs’ rage simmers below the courtesy that modern business practice demands, but that anger foments searches for better solutions in every healthcare niche. Employers and unions are quietly beginning to go around (disintermediate) their brokers and health plans, which have often become the complicit contracting agents for the industry’s excesses. Seen from this perspective, direct contracting’s potential is virtually limitless. Maria has been doing direct deals with Fortune 1000 companies since 1993.
The beauty of direct deals in the ERISA market is that there's no capitation, denied claims are reduced, lost claims are reduced, payment is accelerated, and you get to build RELATIONSHIPS that are lasting and trusting and meaningful. The managed care contracts you sign are the antithesis of this because they say it on record "NO THIRD PARTY RELATIONSHIPS" which means you only have a contract with the ASO or HMO or TPA, not the one who writes the checks and makes the payment decisions.
If your health system can prove your assertions with solid externally audited and verified data, and has a trustable brand, you are ready to take this class and "plow the road". You'll realize as much as 20% better financial performance per contract. You'll have more money in your lock box, sooner, with less hassle, less contract negotiating cost, fewer denials and refund to process, and no surprises on web-based contract amendments and other nasty little payer antics.
Join Boeing Company, Walmart, Delta Airlines, and many others ready to sign your deal if the deal is mutually beneficial. You can share risk for your outcomes and cost containment performance in meaningful ways, but without capitation by putting your revenue at a little risk against targets that can be validated. Maria shows you innovative ways to structure those deals and gives you model templates to take home. Maria has taught leading branded hospitals all over the world how to get in on the disintermediation train to better outcomes at better prices and better payer relationships. The other thing to consider is that you don't have to have the same deal with each corporate buyer. You can have flexibility that isn't possible in HMO and PPO contracts.
What the Modern Healthcare article didn't explain well is that health system executives would be reluctant to cut prices to the bone. That's okay because they don't need to! The reasons for this have to do with the ERISA plan administrator's fiduciary liability exposures. Too cheap is as risky for them as too expensive. Maria teaches you from experience what's reasonable and how to negotiate it.
There's room for underdogs in this arena
Even with the leverage their local dominance lends them, large institutions may not necessarily dominate healthcare marketplaces in the future. Around the country, small, specialized, scalable organizations have learned to manage care and cost in high-value healthcare clinical and financial niches, such as cardiovascular conditions, musculoskeletal disorders, cancer, drugs, surgeries, primary care, hospitalizations, imaging, large case management and centers of excellence. Maria shows you how the deals work, what they look like and how both large and small hospitals, CAHs, ASCs, and rural and urban setting hospitals can win in this race. The ones that will fare best are those who are proximate to an airport or transit center, have a glowing reputation and brand, good quality care, a service orientation, and can bundle case rates or portions of cases (like medical tourism) and make doing business with them as easy as possible. You don't need to hunt for customers in the international market, either. You can find exclusive steerage deals across the street, across the county, across the state, or in another state.
Can you save an employer $15K across an episode of care on hearts, transplants, spine and other surgeries? That's your threshold for a medical tourism pitch. Can you save the employer on everyday services without travel costs? Give better service and neutralize their PPO leasing costs ($≅8 PEPM) They would be ready to talk and will kick the PPO to the curb and only buy spot savings on out of network services if they believe you. Start with a pilot program that can save them a nice chunk of money within a particular specialty. They will come back for more in 6 months and ask "This is great! What else can we buy from you this way?" What HMO or PPO will have a discussion like that with you over a cup of coffee?
Come learn how to be a real disrupter, ready to contract directly with employers. You will leave empowered, and ready to begin your strategic fine tuning as soon as you get back to your office. Maria sends you home with sample letters, market insights, leads with names and phone numbers of decision makers at Fortune 1000 companies, unions, and other prospects, a template contract and an understanding of how to use the template, how to adapt it to your situation, and more.
About the Workshop Leader: Maria Todd
Maria Todd specializes in business improvement strategies and tactics for healthcare and health tourism organizations. Her public and in-house seminars and workshops on negotiation, contract management, analysis, marketing and branding are highly regarded on five continents. She is the author of 15 internationally published handbooks on contracting, medical tourism, concierge medicine, and physician integration and alignment. Her customers include some the largest and best-managed healthcare and tourism industry providers in the world. Since 1983, Maria Todd has trained more than 60,000 healthcare industry professionals in over 2800 presentations. She brings her programs on payer contract analysis and negotiation to clients on request. All Maria’s programs are available for a modest flat fee enabling you to provide training for an unlimited number of staff members. Call 800-209-7263 for more information. Check out the heady client list of those she has helped over the past three decades.
The Art of Disintermediation: Direct with Employer Contracting® is a powerful, two-day, interactive workshop with the doyenne of direct with employer contracting. Maria Todd. Most of her students agree that they know what they want to achieve, but they aren’t sure how to go about getting it. Disintermediated contract negotiation is not linear. Corporate buyers view the value of a healthcare provider differently than the healthcare provider sees itself. No matter how diligently healthcare providers and suppliers prepare – they encounter surprises. Some surprises infuriate you, some frustrate you, and others change your perspective.
Course Learning Objectives
The Art of Disintermediation: Direct with Employer Contracting® workshop focuses on how to conduct your fact finding, brand value assessment, payer due diligence, learning your customers’ objectives and goals, and accepting that there will be things you cannot know in advance. Then you make it your business to prepare for what you can and do know. You learn the scope and issues that the payer wants to focus on, you prepare several options to resolve each one of them, and you study the nature of your current and past relationship with your counterpart. But then, on arrival at the appointed meeting time and place, armed with data and information, your job as a negotiator is to be prepared to learn, adapt and influence – on the fly. Those who fail in payer contract analysis often fail because they expect to be able to read the contract, decide if the fee schedule is adequate and hurry to sign. The language analysis is usually their weakest skills set. And it isn't full of legaleze. It's right there in plain language, just nobody taught you how to perform the critical analysis of the words on the page.
In The Art of Disintermediation: Direct with Employer Contracting® workshop, Maria Todd teaches participants the art of critical thinking, reading, and avoiding loopholes. That’s how you learn your counterpart’s hidden agenda, constraints, objectives and goals. It is also where you discover opportunities, mutuality, and the nature of your value proposition – as seen from your counterpart’s perspective. In the interactions that lead to your negotiation meeting, you must have a roadmap and system that helps you conduct due diligence, verify references and conduct towards others, determine your leverage and build a negotiation strategy that identifies the value on what it is you can bring to the deal.
Many bloggers, consultants and speakers at conferences talk and write about contracting strategy. Their speeches and slides, webinars, and blog articles offer popular and intriguing cookie cutter strategies that crumble in the real-world analytical phase. Many of their articles and speeches fail to take into account real-life and real-time nuance, history, relationships, and market realities that are all critical to the deployment of their recommended cookie-cutter strategy. Very few of these marketers have actually mastered payer contract analysis themselves. The proof is in the complaints of poor reimbursement and bad contract terms found in most payer agreements for hospitals, labs, pharma, imaging, clinics, medical supply, and other provider participation agreements. Further proof is found in how they play out in terms of getting paid what they negotiated and expected more often than not.
The Art of Disintermediation: Direct with Employer Contracting® is all about critical analysis of the market, defining the offer (both language and rates+incentives). Maria teaches participants how to develop fall back strategies if the offer you’d like to negotiate isn’t what’s on the table. She teaches a framework for obtaining clarifications without seeming confrontational.
Most health facilities, physicians, laboratories, pharmaceutical manufacturers and integrated health systems cannot approach managed care payer contract analysis casually. They face the harsh reality that when they are analyzing a payer contract with one insurer or third-party payer, their must have a specific list of objectives they need to ensure are included in the deal. The time to plan for that and set it up is before the negotiation meeting, not while at the table or on the phone.
The Art of Disintermediation: Direct with Employer Contracting® is about precision that a due diligence demands. This is not an appropriate class for new managed care entrants. Consider taking this class if you have been working in managed care contracting for 5-7 years or more. You'll learn about the ERISA and Taft Hartley plans. You'll learn where the weak spots are and how to reinforce them. You'll also come away with skills that will bolster your "All Products" HMO and PPO deals. You'll learn where to find helpful information that you were always told was "Proprietary", but maybe isn't, and she will share her health law paralegal training to show you how to create fallback strategies and marketing pitches to round out the mechanics of the contract template she supplies to take home.
The two-day, interactive workshop, The Art of Disintermediation: Direct with Employer Contracting® is broken up into three focus sections over the 12 hours that account for the majority of healthcare reimbursement contracts:
- Analyzing the buyers' needs
- Understanding ERISA and Union rules and state self-insured deals and how they differ
- Analyzing (and drafting) contracts that are direct relationships with self-funded and self-insured employers and labor unions (the term for this is "disintermediated" because it doesn't go through an HMO or PPO or TPA.)
Maria Todd begins the Master Class and workshop from the point where you are faced with developing a strategy, have not yet performed the due diligence, and must analyze contract language and determine what changes you’d like to achieve. Maria spends time with each student in front of the others so that everybody learns from their peers as well as from her. She teaches the workshop participants how to be more critical and effective analysts and researchers. She explains how to deal with what they find, what they don’t like and how to determine how much it matters -- before the appointment at the negotiation table or on the phone. In The Art of Disintermediation: Direct with Employer Contracting®, Maria shows participants how important aspect of analysis is in due diligence, market research.
In The Art of Disintermediation: Direct with Employer Contracting®, Maria Todd zeros in on language and operational pitfalls you find in HMO and PPO contracts that don't apply in this setting. She provides insights on rate calculations at a strategic level. She connects healthcare product and service marketing, branding, quality, safety, service and accreditation to situational awareness. She teaches how to deal through the landmines that await most providers. She explains how to tweak language loopholes to level the playing field. You will benefit what you learn in the workshop and be able to apply it immediately. You'll have a fresh and practical streamlined slant that will push you to rethink your habits and assumptions about contracted reimbursement that feels good psychologically and financially.
DATE: 24-25 October, 2016 (9-4:30p)
LOCATION: Hyatt Place Denver Downtown, Denver Colorado
The Art of Disintermediation: Direct with Employer Contracting® is a registered trademark of Maria K Todd
What Maria Todd Covers in this Master Class
We want to ensure that you get the training you need. If the skills you want and need include:
- Understanding disintermediation opportunities, payment models and employer requirements for corporations, unions, and state employers
- How to work with draft language and fee schedules customied to buyer needs
- How to analyze the employer's potential book of business, market conduct, history and brand value
- How to conduct employer due diligence during the pre-negotiation phase
- How to organize a medical tourism product with direct to employer contracts if you believe you are ready
- How to develop business rules for every corporate direct contract
- How to integrate services through an IPA, ACO, PHO or MSO
- Internal and external data mining and interpretation to prepare your unique corporate contracts
- How to respond if your HMOs and PPOs balk
This is the course you should plan to attend.