Managed Care & Contractual Services Discussion Essay
In preparing for this discussion, read Chapters 4 and 6 of the course text. For your initial post, address the following in the discussion forum:
Discuss common issues in the contracting process.
Describe four provider obligations commonly included in managed care contracts.
Explain the importance of provider contracts in maintaining a provider network.
Your initial post should be at least 300 words. Support your response with a minimum of two credible sources (Links to an external site.) that were published in the last five years.
Required Resources
Text
Kongstvedt, P. R. (2012). Essentials of managed health care (6th ed.). Sudbury, MA: Jones and Bartlett Publishers.
Chapter 4: The Provider Network
Chapter 5: Provider Payment
Chapter 6: Legal Issues in Provider Contracting
Recommended Resources
Articles
Ambres, C., & Jamilkowski, M. (2015). Preparing for bundled payments: With the increasing significance of bundled payments in health care, providers should take steps to optimize their readiness in several key areas (Links to an external site.). Healthcare Financial Management, 69(6), 86-90. Retrieved from https://www.hfma.org/hfm/
The authors urgent providers to be ready for bundled payments and focus on five key areas: (a) data analytics and benchmarks; (b) technological components; (c) care delivery guidelines; (d) care system redesign; and (e) contractual considerations.
Eijkenaar, F. (2013). Key issues in the design of pay for performance programs (Links to an external site.). European Journal of Health Economics, 14(1), 117-131. doi: 10.1007/s10198-011-0347-6
The full-text version of this article can be accessed through the EconLit database in the University of Arizona Global Campus Library. The author discuses common key issues in P4P programs and purposes recommendations for better design of P4P programs.
Fink, J. (2015). Mandatory bundled payment: Getting into formation for value-based care: Success under Medicare’s new mandatory bundled payment model will depend on strong collaboration among hospitals, physicians, skilled nursing facilities, home health providers, and others (Links to an external site.). Healthcare Financial Management, 69(10), 55-63. Retrieved from https://www.hfma.org/hfm/
This article describes CMS’ first mandatory bundled payment initiative, Comprehensive Care for Joint Replacement model, and stresses that the success of this model will require the collaboration among various healthcare providers and financial arrangements to align incentives.
Punke, H. (2012, December 28). 5 payment models for ACO providers. Retrieved from http://www.beckershospitalreview.com/hospital-physician-relationships/5-payment-models-for-aco-providers.html
This article highlights five payment models commonly found in accountable care organizations (ACOs).
Stanowski, A. C., Simpson, K., & White, A. (2015). Pay for performance: Are hospitals becoming more efficient in improving their patient experience? (Links to an external site.) Journal of Healthcare Management, 60(4), 268-284. Retrieved from https://ache.org/pubs/jhm/jhm_index.cfm
The authors conducted a research study and found that hospitals are becoming more efficient in delivering care associated with higher levels of patient experience, coinciding with implementation of the P4P programs.
Multimedia
Compass PHS. (2013, November 13). Health care price-transparency: Provider-Network contracting (Links to an external site.) [Video file]. Retrieved from https://www.youtube.com/watch?v=rV9d39rdSD0
Dr. Eric Bricker explains four types of insurance network provider contracts: (1) case rates; (2) percent of charge; (3) carve out; and (4) provider stop-loss.
Accessibility Statement (Links to an external site.)
Privacy Policy (Links to an external site.)
The Boston Consulting Group. (2012, June 19). Michael Porter on paving the way for value-based health care (Links to an external site.)[Video file]. Retrieved from https://www.youtube.com/watch?v=KXecsdrQ-YI
Professor M. Porter discusses his thoughts regarding value and cost in health care.
Accessibility Statement (Links to an external site.)
Privacy Policy (Links to an external site.)
Web Pages
RAND. (2015). Health care pay for performance (Links to an external site.). Retrieved from http://www.rand.org/topics/health-care-pay-for-performance.html
This web page houses research publications regarding P4P in health care.
Robert Wood Johnson Foundation. (2015). Value-based payment reform (https://www.rwjf.org/en/library/collections/health-care-payment-reform.html). Retrieved from https://www.rwjf.org/en/library/collections/health-care-payment-reform.html
This web page houses research publications regarding healthcare payment reform.
Website
Center for Healthcare Quality and Payment Reform. (2015). Physician-focused alternative payment models. (Links to an external site.) Retrieved from http://www.chqpr.org/
This website houses research publications regarding physician payment models.
Report
American Association for Physician Leadership & Healthcare Financial Management Association. (2015). Designing the new health care system: The need for CMO and CFO collaboration (https://chqpr.org/). Physician Leadership Journal, 2(4), 8-17. Retrieved from http://www.physicianleaders.org/news/journals/plj
This is a joint report from the American Association for Physician Leadership® and Healthcare Financial Management Association. Because of current market demands and forces, there is a need for collaborative leadership between CMO and CFO to improve patient safety, health outcomes, transparency, and affordability of health care.
