Healthcare finance leaders can expect to see significant use of value-based approaches to healthcare delivery and payment. In addition to approaches advanced by the Centers for Medicare & Medicaid Services (CMS), commercial health plans are initiating value- and risk-based approaches to varying degrees and depth in diverse markets. A non-negotiable element of this new value equation for insurers and providers is the need for an unremitting focus on improving quality, access, and efficiency.
6 Key Practices for Effective Managed Care Contracts
There are six practices that provider organizations should use in their assessment of any contract, whether risk-based or fee-for-service with pay-for-performance components.
- Ability of the organization to meet contract requirements
- Terms proposed by the health plan
- Coding requirements
- Necessary data
- Standard-of-care metrics
- Contract flexibility