managed care - contact negotiation - healthcare management - MDP Boston

Managed Care
Negotiating contracts for success

Dramatic changes in the economics of providing health care has created an increased reliance on Managed Care contractual agreements. This has afforded MDP the opportunity to establish itself as the leading contract negotiations specialists in this area. We ensure contract negotiations include attention to a fine level of detail in terms of definitions, covered services and everything in between. The reimbursement rate is only one piece of the puzzle. Often times there are not only marketing, service and accessibility issues, there are also elements such as precisely defining what benefits are covered, stop loss provisions, various incentives and provisions about how members are counted and properly allocated.

Managed Care services offered:

• Market and negotiate Managed Care Organizations (MCO) contracts
• Capitation expertise
• Contract Physicians into Networks (IPA)
• Credential physicians with MCO's
• Utilization Management and Quality Assurance
• Negotiate and manage financial "Risk Pools"
• Referral coordination services and information systems

Competition is fierce for securing the best Managed Care contracts, yet, despite the current rush to sign as many contracts as possible, physicians would do well to let our experts take the negotiating process over. Our goal is tough but fair negotiating up front. This can go a long way toward avoiding problems in the future. We get it right the first time. As least half of the issues within a contract can be improved if you clarify these issues from the outset.  Our thorough analysis of the contract ranges from procedure carve outs to termination clauses. We ensure terminology is present that protects you, e.g., clauses allowing you to drop a disruptive or non-compliant patient.

We also offer Capitation and Risk contracting expertise. For many providers, the most common mistake in approaching a Risk contract is understanding their own degree of leverage and to act accordingly. Making sure your contract is a winner depends not only on evaluating your position in the market, but also working collaboratively, displaying flexibility and sharing data with the MCO. This will lead to an agreement that is win-win and to a long term payer-provider relationship.