Increasingly hospitals are walking away from payor contracts. Physicians are not only dropping out of health plan networks, some are not accepting health insurance. And the headlines are carrying the news about physicians-payor lawsuits.
The health costs issue is at the top of the challenge heap for both provider and payor executives this year and that will be reflected in contract negotiations.
How do you get to "yes" in this environment? Can payors and providers find room to reach agreement? Are providers willing to leave money on the table? Results of Managed Care Information Center leadership surveys reflect deep divides depending on whether the respondent was from a provider or payor organization.
The goal of "Can We Get To Yes? Key Issues in Managed Care Payor-Provider Contracting,”is to provide a 360-degree assessment of health plan - provider contracting issues for the coming round of negotiations. MCO consolidation in many key markets may tip the scales. Can hospitals negotiate adequate reimbursement when up against the proverbial "900 pound' gorilla?"
"We demand the latest technology, the newest drugs, and state-of-the-art medical procedures but have little or no understanding of the healthcare delivery costs inherent within each category," a health plan director of product development told us. "Something’s ‘gotta’ give."
Vice President, Managed Care
California Hospital Association
Gregory J. Pepe, Esq.
Neubert, Pepe & Monteith
Pmpm® Consulting Group
- Overview of managed care contracting issues today
- The payor-provider negotiation climate
- Negotiating in the face of HMOs' ever increasing market power
- Reimbursement and contract issues in negotiations
- Review of recent enforcement actions, key court cases, and the regulatory effort to prohibit balance billing
- Regulatory efforts to define and enforce “prompt and fair” payment to non-contracted providers
- The challenges providers face in dealing with high deductible insurance policies
- The consequences of the rapid expansion of “Centers of Excellence” and other similar payor designated networks
- The dispute resolution process
- What California hospitals doing regarding hospital billing and collection practices and charity care
Who Will Benefit From This Teleconference on CD-ROM?
Hospitals, Health Systems, managed care organizations, home health agencies, healthcare providers, disease management companies, CEOs, CFOs, vice president of finance, hospital managers, medical directors, healthcare management, TPAs, network managers, physician practice management company executives, medical management directors, PHO and IPA leadership, financial analysts, implementer consultants, account services and administration executives, administration, billing and accounting, controllers, patient accounts managers.