managed care contracting · pdf filethe purpose of this session is to educate participants on...
TRANSCRIPT
Managed Care Contracting:Optimizing Revenue Streams for All ProvidersBeth Mullins // Bill Hannah
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PINNACLE SPEAKER PROFILE
Bill Hannah
• Principal
• DHG Healthcare
• Atlanta, GA
PINNACLE SPEAKER PROFILE
Beth Mullins
• Principal
• DHG Healthcare
• Fort Worth, TX
Finance Rotation // Managed Care Overview
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PURPOSE:The purpose of this session is to educate participants on the breadth of services offered by the Managed Care contracting team and show how these services align with the DHG Healthcare transformational point of view.
KEY TAKEAWAYS:1. Provider organizations and payers are both trying to navigate the value-based world.2. Constant analysis and monitoring of contracts and contract terms is becoming more and more critical for long term
sustainability.3. DHG Healthcare has the tools and talent to help clients navigate this turbulent time.
LEARNING OBJECTIVES:1. Understand the current managed care contracting environment through the identification and discussion of key trends.2. Learn about the various product offerings being delivered across a variety of healthcare providers.3. Understand the various tools, techniques, and capabilities and how they align with many other DHG service offerings.4. Understand the foundational elements that support clinical and operational processes for a Risk Capable organization
Beyond the Tipping Point // Risk Capability 2.0
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Session Overview
1. Managed Care Practice Overview
Managed Care Service Offerings
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Managed Care Active Clients
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Session Overview
1. Managed Care Practice Overview
2. Fee-for-Service Contracting Strategies
Annual Contracting Cycle
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Current State Assessment
• Anniversary dates & termination provisions
• Market volumes• Contracting plan
Negotiation• Rate optimization• Volume optimization• Annual escalators
Execution• Implementation of
terms • Revenue cycle • Contract management
system
Monitoring• Ongoing review of
financial performance
Maximizing Fee-for-Service Reimbursement (Commercial)
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What initiatives are already in place? What can be capitalized on in payor negotiations?
• P4P Annual Escalator• Withhold Quality Payment• Shared Savings - Upside Only• Shared Savings - Upside/Downside
Cost/Quality
• Carve-Outs• % Increase: Annual & Multi-Year• Charge Master Increases• Bundles
Rate Structures
• Steerage• Narrow Network• % Discount• Centers of Excellence
Volume
• Facility/Professional Negotiation• Multi-Scope: National/Local• Service Lines• OON/Term• Direct to Employer• Lines of Business
Leverage
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Session Overview
1. Managed Care Practice Overview
3. Value-based Contracting Strategies
2. Fee-for-Service Contracting Strategies
Value-based Contracting Approach
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Value-based Contracting Intended Outcomes
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A value-based contracting strategy should accomplish a combination of the following:
Value-based Contracting Glide Path to Risk
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Value-based Contracting Critical Success Factors
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Critical Success Factors: Improve Risk Score
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Critical Success Factors: Improve STAR Rating (MA Only)
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Jiminy Cricket
Beth MullinsPrincipalAtlanta, GA404.575.8951 [email protected]
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Bill HannahPrincipalFort Worth, [email protected]