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?...
Continue reading“Medical Cost-Sharing” Plans: What Your Hospital or Practice Needs to Know Before You Agree
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 readingReference-based Pricing Gets Put to the Test in Virginia
Make no assumptions about reference-based pricing! Not yet, anyway… 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...
Continue readingWhat’s the difference between “best efforts” and “reasonable commercial efforts”?
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...
Continue readingVertical Integration Returns to U.S. Healthcare: What You Need to Know Now
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...
Continue reading#AskMariaTodd: The Proliferation Trajectory of Community-based, Freestanding Emergency Departments
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...
Continue readingThe 340B reductions
So… 340B changes making you nervous? Pull up a chair and pour a cup of tea or coffee. Let's talk about it. 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,...
Continue readingWhy Health Insurers Don’t Offer Plans that Cover Elective Medical Travel
Many healthcare facilities at international destinations have requested my assistance to get contracts with insurers who offer plans that cover elective medical travel. 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...
Continue reading