Advantages Of Direct Contracting

PPO- This plan contracts with physicians and facilities to perform services and a specified rate. Its to ensure that PPO members are charged less than nonmembers

“the contractor shall further insure that all medical, dental, and mental health services are secured from a Medicaid approved provider and that charges for services shall be at the Medicaid approved rates. If no Medicaid provider is available the contractor must make every

Managed care organizations should have arrangement with both the medical insurers and providers to provide treatment for a contracted rate. Hospital should advertise the services they offer to members of healthcare plans through their healthcare provider by emphasizing on the technology, staff, and other quality of care they provide. Worker compensation plans are similar to commercial plans but treats injured employees. Hospital must contract with all workers compensation plans and must also negotiate coordination of benefits with other insurance carriers of the injured person to full compensate services. For Self pay patients hospital can reach out to them by having pre negotiate rates for treatment when payments are made in advance for certain procedures. Hospital should have system to accept payments when made in any

“a) Contracts that explicitly detail the responsibilities of employers as purchasers with insurance, managed care, and hospitals and physician groups as suppliers, b) Information to support the management of purchasing activities, c) Quality management to drive continuous improvement in the process of healthcare purchasing and in the delivery of healthcare services, d) Incentives to encourage and reward consumers, and e) Education to assist employees become better healthcare consumers” (p. 352).

As part of this document, they are encouraging payers to consider directly contracting with them and/or creating a custom network (if their PBM contracts allow for that).

The state healthcare marketplaces have increased new insurance companies in their markets and many of these state healthcare marketplaces will increase new health plans as well. These additional physician opportunities will be imperative for them to understand how the contracting process affects their practices.

Preferred provider organizations offer flexibility in benefit design and allow patients flexibility to choose from a list of in-network providers for their care. Care provided in-network typically is discounted with out of network services resulting in higher out of pocket expenses to the patient (Hirth, Grazier, Chernew and Okeke, 2007). Clinically integrated networks are a more recently developed managed care structure. In this model, independent practitioners form a virtual network as a means of increasing capacity for contracting with payers of healthcare whether commercial insurance or for self-insured organizations. Physicians recognize advantages to collaborative contracting and the increase in coordinating care of patients through the network (Kaplan and Guest, 2012). Commercial insurance companies are looking to clinically integrated networks as another mechanism to control the costs of healthcare delivery. Accountable care organizations, as with clinically integrated networks, are fairly recent phenomenon with similar but more formalized characteristics. An accountable care organization is a structured network of healthcare entities which have united and are responsible for the health of an identified population. The accountable care organization shares the risk of meeting the health needs of

It is crucial to the success of a practice to have a very personalized relationship with the billing company. The billing company should function as an extension of the physician’s office working toward mutual goals.

For all this contracting procedure, physicians can opt to choose a messenger which is known as ‘’messenger model’’ under this the messenger can accept the contract terms from the payers and should inform the physicians and collect the decision unilaterally whether physicians agreed to the terms or not. Similarly, with the consent of physician group messenger can offer the proposed contract by the physicians to payers.

As the CFO of Community Memorial Hospital, I have a major problem on my hands that could lead the hospital in a financial bid. Bill Jacobs, the Human Resource Director of Commercial Intertech (CI) which is the largest employer in the community, has signed a contract MegaPlan Health. MegaPlan is a known insurance company that gives hospitals a very hard time especially when it comes to discounts and fighting claims the hospitals make. Since all of our employees and their families will be using MegaPlan Insurance and Community Memorial is not on their Preferred Provider Network (PPN), I need to figure out if we should work with or without

Direct reimbursement plans are a self-funded plan that involves an agreement between employers and its employees in which employer agrees to reimburse the employees in some part of their expenses for dental care for a provider of their choice (Burt & Eklund, 2005).

Horizontal integration is the expanding of a company through increasing the service to create a stronger and more enhanced company that provides the same service. Vertical integration is when a company owned individual providers create or operates the distribution themselves. In order to provide the best healthcare service, healthcare facilities needs to offer a network of providers with a wide range of healthcare service. The term integration delivery system (IDC), “is a network of organizations that provides or arranges to provide a coordinated continuum of services to a defined population” (Shi& Singh, pg. 366). The goal for healthcare organization is to provide high quality and efficiency of care with cost reduction for healthcare aimed toward the patient population. This goal is not only a great benefit for an organization but for patient and also for healthcare services providers.

In this research paper I will discuss the process of contracting out, issues of cost, credibility, accountability, and quality and quantity of services. My discussion will also include reasons for contracting out, opposition, and advantages and problems of contracting out.

This type of procurement strategy is a ‘fast track’ strategy. Client pays a sum of money to hire a management contractor to manage the whole construction project. Therefore, some early work can be carried out before the design is complete. The contract for the construction projects are between the management contractor and sub contractor. The final cost for the project can not be identified until the final work has been awarded.

Management Contracting – this is where work begin before all design has been completed to contracts are drawn up in stages.