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.

Key Practices for Effective Contracts
Described in this article 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.

  1. Ability of the organization to meet contract requirements
  2. Terms proposed by the health plan
  3. Coding requirements
  4. Necessary data
  5. Standard-of-care metrics
  6. Contract flexibility
6-Practices-for-Effective-Managed-Care-Contracting-Oct-hfm.pdf