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Advancing Community Hospitals

HELP WHERE HOSPITALS NEED IT ®

HELP WHERE HOSPITALS NEED IT ®

Managed Care Evaluation

 

The need to evaluate managed care relationships has become top priority for hospitals and other healthcare providers. With the continual fiscal pressures from governmental reimbursement programs, the need to have positive relationships with managed care providers is often times essential to providing a positive margin from operations.

 

Through the managed care evaluation process, CHC Consulting will conduct a review of current financial information for the top payors for the organization. Assessment of an organization's "Top Five" managed care contracts is the primary focus of the project, seeking opportunities to improve:

  • Contract Terms
  • Reimbursements
  • Carve-Outs

Additionally, the engagement includes an onsite discussion with key administrative members of the organization, to determine the strategic direction and initiatives most critical to capture in the system's payor relationships. The project team also works together to develop tactical recommendations related to relationships, structured negotiations, contract performance and compliance.

Advancing Community Hospitals