A managed care cycle provides contract oversight.
In response to poor payment performance by health plans, providers are realizing that managed care contracts require systematic, ongoing management rather than a periodic focus. An effective managed care cycle that encompasses strategy development, implementation of the strategy through contracting and operations, and monitoring of contract performance can accomplish this needed oversight. Each phase requires specialized management tools, skills, and staff. Because of the importance of managed care to the provider's financial viability, a wide range of persons should be involved in the managed care cycle, including the board of directors, business office staff, senior management, and finance staff. As providers embrace a more structured approach to managed care, they will increase their chances of receiving accurate contracted payments.
Stevenson
Paul B
PB
MedTactics, Arlington, Virginia, USA.
Messinger
Stephen F
SF
Welter
Terri
T
D003284:Contract Services / Q000191:economics / Q000458:organization & administration*; D005249:Fees and Charges; D005377:Financial Management, Hospital / Q000379:methods*; D006075:Governing Board; D007324:Institutional Management Teams; D007349:Insurance, Health, Reimbursement; D008329:Managed Care Programs / Q000191:economics / Q000458:organization & administration*; D017008:Negotiating; D024382:Professional Role; D015397:Program Evaluation; D014481:United States