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1
Managed Care Contracting 101
Building Your Contracting Business Plan
2
The Business Plan
Conduct internal assessment– Begin assessment at least 8
months prior to contract end/renewal date
– Review historical business volume among various payer or provider clients
– Evaluate current contract performance gaps
– Solicit internal stakeholder input
– Establish desired objectives under new contract
– Have financial team prepare pro-forma with future performance goals
3
The Business Plan Continued
Assess current external business environment
– Inventory competitors, market share, best practices, short-comings
– Make best estimate of provider/payer business conditions
– Review governmental and regulatory conditions, current and projected
– Determine implications for your business
4
The Business Plan Continued
Prepare a contracting calendar
– Prioritize projects by business volume/need for new contract
– Establish timeline for negotiations
– Set start date, milestones and end date
– Communicate timeline with internal stakeholders
– Record and communicate progress, barriers, action plans and resolution steps
5
The Business Plan Continued
Contract negotiations process
– Conduct up kick-off meeting with client
– Share performance outcomes and objectives under new contract terms among parties
– Come prepared with business volume metrics
– Schedule follow-up meetings/feedback frequency
– Meet timelines for all parties and address issues promptly
– Ensure contract terms can be administered by all parties
6
The Business Plan Continued
Post Negotiation Steps– Communicate results with internal stakeholders– Conduct informational meetings/distribute
communication vehicle across organization– Develop contract performance monitoring process
Set up database retrieval format for monitoring Evaluate performance at least quarterly Investigate gaps between actual and desired
performance; make corrections as necessary
7
The Business Plan
Important Tips! – Treat parties as business
associates not adversaries– Start negotiations early and
communicate often– Hold periodic meetings with
client to ascertain issues and maintain favorable relationship
– Keep diary of meetings, follow-up actions and commitments
– Make sure contract terms can be administered