Managing and Measuring Payer Performance
Healthcare providers should have a contract management system as the framework for managing the four components of the governance/communication processes―contract analysis and modeling, payment calculations, variance monitoring workflow, and payer scorecard and reporting.
Ask the Experts: Contracting with Small Health Plans
When negotiating with large and small health plans, what areas of comparison should I look at to be sure I am getting the same levels of service from the various plans?
Video: Tips for Direct-to-Employer Contracts from UNC Health
Understanding the time commitment and negotiation strategies around direct-to-employer contracts are key areas for payment and reimbursement leaders to consider.
Demand Fuels Expansion of Tiered-Benefit Insurance Products
Stephen T. Swift of BlueCross BlueShield of Western New York writes that collaboration with local healthcare providers spawned a popular tiered-benefit insurance product.
Negotiating a Joint-Venture Health Plan
Aspirus is one of many health systems that partner with insurance companies to form joint-venture health plans that bring healthcare financing and delivery closer together.
Contracting for Chronic Disease Management
Illinois Gastroenterology Group negotiated a specialty intensive medical home contract with the state’s largest private payer.
Partnering With Healthcare Purchasers
Mount Sinai Health System partnered with a trade union to develop a bundled-payment program designed to improve patient outcomes and reduce the purchaser’s costs.
Winning Direct Contracts with Employers
Pacific Business Group on Health, a leader in direct contracting, uses an extensive evaluation process to choose the provider organizations for its Employers Centers of Excellence Network.
Hospitals with PBGH Joint Replacement Contracts
Pacific Business Group on Health (PBGH), a membership organization that includes many of America’s largest healthcare purchasers, has developed direct contracts for joint replacements, spine procedures, and bariatric surgery with hospitals across the country.
Ask the Expert: PMPM Payments for Case Management
PMPM payments for case management.