Can We Get To Yes?
Key Issues in Managed Care Payor-Provider Contracting
MANASQUAN, N.J. — Increasingly hospitals are walking away from payor contracts. Physicians are not only dropping out of health plan networks, some are not accepting health insurance. And the headlines are carrying the news about physicians-payor lawsuits. The health costs issue is at the top of the challenge heap for both provider and payor executives this year and that will be reflected in contract negotiations.
How do you get to "yes" in this environment? Can payors and providers find room to reach agreement? Are providers willing to leave money on the table?
To explore these issues, the Managed Care Information Center has scheduled "Can We Get To Yes? Key Issues in Managed Care Payor-Provider Contracting,” a special executive-level teleconference. This program is scheduled for Thursday, October 27, 2005 at 1:30 p.m. ET.
The goal of this conference call is to provide a 360-degree assessment of health plan - provider contracting issues for the coming round of negotiations. MCO consolidation in many key markets may tip the scales. Can hospitals negotiate adequate reimbursement when up against the proverbial "900 pound' gorilla?"
"We demand the latest technology, the newest drugs, and state-of-the-art medical procedures but have little or no understanding of the healthcare delivery costs inherent within each category," a health plan director of product development told us.
Presenters Dietmar Grellman, Vice President, Managed Care, the California Hospital Association; Gregory J. Pepe, Esq., Principal, Neubert, Pepe & Monteith; and Russell Foster, Principal, Pmpm® Consulting Group will cover topics including:
- An overview of managed care contracting issues today
- The payor-provider negotiation climate
- Negotiating in the face of HMOs' ever increasing market power
- Reimbursement and contract issues in negotiations
- Review of recent enforcement actions, key court cases, and the regulatory effort to prohibit balance billing
- Regulatory efforts to define and enforce “prompt and fair” payment to non-contracted providers
- The challenges providers face in dealing with high deductible insurance policies
- The consequences of the rapid expansion of “Centers of Excellence” and other similar payor designated networks
- The dispute resolution process
- What California hospitals doing regarding hospital billing and collection practices and charity care
A live question and answer session will also be included in the audio conference.
How to Register
To register for “Can We Get To Yes? Key Issues in Managed Care Payor-Provider Contracting,” visit www.healthresourcesonline.com/edu/mcc.htm, call (800) 516-4343 or e-mail firstname.lastname@example.org.
Cost of the conference is $227 per site if registered by October 14 (and $277 after). A CD will also be available for purchase for those unable to attend the live conference. For further details and other pricing options, visit www.healthresourcesonline.com/edu/mcc.htm.
Address: Managed Care Information Center, 1913 Atlantic Ave., Suite F4, Manasquan, NJ 08736; (732) 292-1100, www.themcic.com
Date: October 6, 2005
Contact: Sharon Sudol
Phone: (732) 292-1100, ext. 21