Healthcare Intelligence Network
Accountable Care Organizations
Best Sellers
Behavioral Healthcare
Bundled Payment
Care Coordination
Care Transitions
Case Management
Chronic Care Management
Coming Soon
Community Health
Cultural Diversity
Data Analytics
Diabetes Management
Disease Management
Dual Eligibles
Emergency Medicine
Health Literacy
Health Risk Assessments
Health Risk Stratification
Healthcare Reform
Healthcare Trends
HIN Benchmark Reports
HIN Case Studies
Home Health
Home Visits
Hospital Readmissions
Infection Control
Information Technology
Long-Term Care
Managed Care
Medical Home
Medical Neighborhood
Medical Practice
Medical Records
Medication Adherence
Nurse Management
Palliative Care
Patient Engagement
Patient Experience
Patient Registry
Pay for Performance
Physician Practice Transformation
Physician Organizations
Physician Quality Reporting Initiative
Population Health Management
Post-Acute Care
Predictive Modeling
Quality Improvement
Remote Patient Monitoring
Revenue Cycle Management
Social Health Determinants
Training DVDs
Value-Based Reimbursement
What's New
Subscribe to the Free
'Healthcare Business Weekly Update' e-Newsletter and receive the latest trends, news and analysis in healthcare.

Click here to view this week's issue

Can We Get To Yes? Key Issues in Managed Care Payor-Provider Contracting, Audio Conference on CD-ROM
Be the first to review this item
Your Price:
Add to Wish List
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."


Dietmar Grellman
Vice President, Managed Care
California Hospital Association

Gregory J. Pepe, Esq.
Neubert, Pepe & Monteith

Russell Foster
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.

Publication Date: October 27, 2005
Frequently Bought Together
Tiered Networks in Healthcare: The Impact on Quality Improvement, Cost Reduction and Customer Satisfaction
Tiered Networks in Healthcare: The Impact on Quality Improvement, Cost Reduction and Customer Satisfaction
Your Price: $247.00
Social Determinants and Population Health: Redesigning Care Management to Bridge Clinical and Non-Medical Services

Copyright Healthcare Intelligence Network. All Rights Reserved. eCommerce Software by 3dcart.