Managed care contracting and payment reform: avoiding a showdown.
Health reform promises to fundamentally change what and how CMS and commercial payers reimburse providers. Providers need to transition from their traditionally adversarial, transactions-based payer relationships to ones that optimize purchaser and patient value for the dollar. To avoid negotiation table showdowns and to prepare for reform, commercial payers and providers should take three actions: Recognize the dead ends with their historical relationships. Formulate their road map to value-based contracting. Avoid operational pot-holes along the way.
Nugent
Michael E
ME
Navigant Consulting, Inc., Chicago, USA. mnugent@navigantconsulting.com
D014487:Centers for Medicare and Medicaid Services, U.S.; D004469:Economics, Hospital / Q000458:organization & administration; D017598:Efficiency, Organizational; D018166:Health Care Reform; D006801:Humans; D008329:Managed Care Programs; D012051:Reimbursement Mechanisms / Q000458:organization & administration*; D014481:United States