Rating managed care plans as business partners.
Managed care plans are driven to meet consumer quality of care demands. But, plans that meet these consumer demands do not necessarily meet provider expectations for quality business partnerships. Therefore, providers need to develop not only clinical performance indicators but also indicators that will help them evaluate managed care plans as business partners. Performance indicators should be developed to measure managed care plans' medical loss ratio, compensation cost/benefit, payment promptness, authorization convenience and promptness, insurance verification convenience and promptness, payment accuracy, medical management, provider relations responsiveness, member education effectiveness, recorded complaints, risk transfer, contract terms, and contract equity.
Barber
R L
RL
Carolinas Hospital network, Charlotte, NC, USA.
D002204:Capitation Fee; D003284:Contract Services / Q000331:legislation & jurisprudence / Q000458:organization & administration / Q000592:standards; D003362:Cost-Benefit Analysis; D005375:Financial Audit; D007318:Inservice Training; D008329:Managed Care Programs / Q000191:economics* / Q000458:organization & administration / Q000592:standards; D017008:Negotiating; D009935:Organizational Affiliation / Q000191:economics*; D011787:Quality of Health Care; D012051:Reimbursement Mechanisms; D012308:Risk Management; D014481:United States