Question

In your own words, explain contracting approaches for physicians and hospitals under managed care plans.

Please note that only original material earns points. Including a reference is required for any source you use. However, you need to include quotes for any copied material. Also you need to compose the majority of the post in your own words so use quotes sparingly. Follow the 80/20 Rule.

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Answer 1

Every Physician and hospitals face difficult and important decisions in managed care contracts. This requires some common rules for immutable manged care contracting. Some common rules to be followed are-

Follow the rule of ‘No contract is better than a bad contract’, ‘Bad contracts rarely get better with me’ ‘3^rd party deals bad contracts often then good ones’. If keeping in mind these three rules, physician and hospitals come into contract it will be beneficial.

Some common contracting approaches followed in Managed acre contracting from physician and hospital perspective are-

1. Traditional market driven contract – It is for small Practioner. It involves low risk, low investment, minimum performance and payer will define market payments and process. It is the most common practice in Managed care.
2. Enhanced market driven- For group practice, it has moderate risk with some investment. Enhanced performance which is linked to strategy. It largely favours the payer.
3. Redefining cost plus- It is clinically integrated approach. It is strategy driven approach which involves high risk and high returns. Good relationship with payer.
4. Modified cost plus- It is mainly for PHO and big hospitals. It involves higher risk, moderate investments, performance is better than average with balanced outcome.