Today's heath care marketplace is highly competitive, requiring managed care providers to contract with dozens of insurers to survive. Each of these contracts comes with their its unique terms and conditions-making the contracting process overwhelmingly complex and giving many health care executives major headaches.
Written by three of the country's leading health care consultants and attorneys, Managed Care Contracting is the first book to offer executives with no legal background practical, step-by-step advice on how to create winning contracts between health care organizations, payers, and employers. In straightforward language, free of legalese and jargon, this much-needed resource demystifies managed care contracting and prescribes some critical advice for hospital and physician group practice executives.
The authors present helpful guidelines for evaluating the various types of managed care contracts and explain the most significant terms and concepts executives are likely to encounter.
"Managed Care Contracting is a very timely
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WILLIAM A. GAROFALO is vice president of Health Care Services with ML Strategies. He is the former leader of health care consulting for KPMG Peat Marwick's New England region and has worked nationally on a variety of managed care projects. EVE T. HOROWITZ is of counsel with the Health Services Group of the Mintz, Levin, Cohn, Ferris, Glovsky, and Popeo, P.C law firm. She routinely advises physicians on managed care issues as a member of the American Medical Association's Doctors' Advisory Network™. THOMAS M. REARDON is co-chair of the Health Services Group of the law firm Mintz, Levin, Cohn, Ferris, Glovsky, and Popeo, P.C. He is a member of the board of directors of Harvard Medical Center and CRICO (professional liability insurer for Harvard affiliated teaching hospitals).Review:
"Managed Care Contracting is a very timely book by some true experts in the field. This book is an indispensable guide to contracting from all perspectives. It couldn't have come at a better time as we all grapple with the rapid evolution of managed care." —Jay M. Gellert, president and CEO, Foundation Health Systems, Inc.
"This book will be a valuable resource for physicians and hospitals as they embark upon risk contracting relationships. Providers need to have a clear understanding of the potential pitfalls that lie along the road of contract negotiations. Managed Care Contracting outlines those aspects of contracting that should be of greatest concern to providers over the long term. Providers will be well-served by reading, learning, and incorporating the principles outlined in this book." —Ellen Zane, network president, Partners HealthCare System, Inc.
"With the advent of Physician Hospital Organizations (PHOs), and their appetite for accepting medical risk transfer from managed care organizations, it is essential for PHO managers to understand what they have accepted. These new organizations must build the administrative infrastructure to manage the risk they have assumed. Managed Care Contracting will help further the knowledge of these managers, while also providing building blocks for success.""Contracting with managed care organizations is an essential survival skill in modern medicine, yet few health care professionals acquired the necessary tools as part of their professional preparation. While it used to be sufficient just to be professionally outstanding, it is now also necessary to negotiate one's opportunities with wisdom and skill. Without that skill, professional training and talent are at risk of sitting idle on the sideline. Managed Care Contracting, authored by experienced experts, will help to fill a void." —Robert Campbell, executive vice-president, Family Health Plan, Inc.
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Book Description Jossey-Bass, 1999. Hardcover. Book Condition: New. Never used!. Bookseller Inventory # P110787945811
Book Description Jossey-Bass, 1999. Hardcover. Book Condition: New. Brand New!. Bookseller Inventory # VIB0787945811