Health Plan Contract 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 commercial health plans is oftentimes essential to providing a positive margin from operations. Through the health plan contract evaluation process, CHC Consulting will conduct a review of current financial information for the top payers for the organization.

Benefits

An onsite discussion with key administrative members of the organization sets the priorities most critical to improve in the system’s payor relationships.


The project team collaborates to develop tactical recommendations related to relationships, structured negotiations, contract performance and compliance.


Assessing an organization’s “Top Five” managed care contracts helps the hospital maximize results from improving contract terms and carve-outs.

“A significant component of healthcare organizations’ revenue comes from health plan contracts, so it is important to know what your health plan contracts look like and look for opportunities to modify those arrangements to maximize your reimbursement.”

~Dave Koford, CHC VP Health Plan Contracting

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Blog

Negotiating Health Plan Contracts: Best Practice Tips

For hospitals, “care” typically refers to providing patient care. Yet a hospital’s financial health requires care and attention, too.

A sound financial strategy supports the provision of patient care and services communities need, and a significant component of healthcare organizations’ revenue frequently comes from health plan contracts.

So what do your health plan contracts look like? Have you reviewed them recently? Are there opportunities to modify those arrangements to maximize your reimbursement?

Here are some best practice tips for health plan contracting.

Review your health plan contracts regularly –...


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