Welcome to my blog! This is a blog, or communication media, to discuss and review all things related to managed care from the provider’s point of view. We will take on the difficult subjects related to contracting and focusing on issues that can be turned into opportunities. Issues such as:
- Leverage in contracting
- Contracting language
- New issues we see in contracting
- Tiered networks
- Narrow networks (formally known as HMO’s)
- Defined contribution rather than defined benefit plan designs
- Public and private exchanges
- Steerage
In addition, we will look at a host of other subjects related to contracting. We will go into the details of what it means to be clinically integrated; what are alternatives; what are the advantages and disadvantages; why measures do and do not work; how to integrate with the hospital and much more as CIN’s continue to develop.
With this we will have to discuss new frontiers in physician hospital integration including bundled payments; employed providers; sharing bonus money both from population health and gain share or shared risk. We will review the need, and how to change the way in which physicians conduct business from a fee for service environment to a population health and healthy population model, and how/where does the hospital fit into this new paradigm.
I welcome your feedback as well as your suggestions regarding what you would like to learn about and see on my blog. If there is an issue or situation that you have recently encountered for the first time– I definitely want to hear about it. We need to spread the word as to what the newest trends are and how we can work with the diminishing number of payers in the most effective and profitable way while keeping the patients as healthy as possible.
A little about who I am, and why you should invest your time in reading what I have to say.
I am the CEO and Founder of IMCS—Innovative Managed Care Solutions; a CPA by education and training, and formerly an audit manager for a Big 6 firm (back when there were at least six). I have been working with providers, forming strategies, negotiating and implementing managed care agreements; and dealing with the day to day issues related to those agreements since 1992– or nearly 25 years.
I have in the past, as well the present, worked exclusively with providers. I have worked with large multi-state hospital systems, community hospitals, employed physicians, large physician groups and small offices, and I am an industry leader in working with Clinically Integrated Networks. I do possess strong analytical skills (it comes with the accounting background), but I am also very practical and understand a managed care agreement, not only from its technical merits, but from a practical and operational view.