Why is the process of renewing and renegotiating #managedcare #contracts still such a challenge for providers? Are they not utilizing the tools properly? Are they not adding the contracts into their systems properly? Do the tools have some necessary features missing? Is there some other reason?...
By MARIA K TODD, MHA PhD Know the financial risks associated with these plan participants and prepare in advance to protect your business. What they are Medical Cost Sharing plans claim to be an alternative to health insurance. That confuses healthcare providers and their revenue management team members immediately. Learn what you need to...Continue reading
Reference-based pricing in healthcare is an interesting concept. What it is and how it works: Reference-based pricing is a relatively new healthcare reimbursement model where employers contract with a company to negotiate payment rates outside a traditional HMO or PPO contractual relationship and pay hospitals a negotiated amount based on a multiple of Medicare’s...Continue reading
This morning, as I was contemplating what to write about for today's article, I received an email from a client who red lined an offer from a health plan for the new Medicaid Managed Care initiative in Illinois. It seems the payer did not want to accept the proposed revision to change from...Continue reading
In the 1990s, during the Clinton Administration, the USA saw many attempts to achieve vertical integration in healthcare. Here we are again! New acronyms were initiated and made popular to describe Independent Practice Associations (IPAs), Physician Hospital Organizations (PHOs), which were managed and administered by entities known as Management Services Organizations (MSOs). Physicians felt the need to group up into...Continue reading
Recently, I've been taking calls from venture capital investment funds and bankers curious about my impression and experience with community-based freestanding emergency departments. Most of the questions are similar: Why this, why now, what's next, hurdles and obstacles? They also want to know if I can share any proven contracting strategies with third party...Continue reading
As you may have heard, new 340B guidelines announced in November 1, 2017 and became effective January 1, 2018. Since the announcement I've been working with hospitals on strategies to implement, extend, and optimize participation in the 340B program. The back story On November 1, Centers for Medicare and Medicaid Services (CMS) issued its 2018...Continue reading
Some have heard through various advertising by consultants and medical tourism trade associations that this was possible so naturally, they want a piece of the action and an opportunity to receive patient referrals from insurers. After all, it makes logical sense that an insurance company would like to save money, right? To bust the...Continue reading