Managed Care Organization (MCO) Team Project “Contracts Review”
You are the new CFO, of Medical Center, a 120 multi-skilled level three (3) healthcare facility.
You have summoned a team of healthcare and business experts to assist with the process of contract negotiating.
Based on the federal mandate of the Affordable Care Act (ACA), prepare a proposal summarizing the team’s final recommendations in
preparation for an upcoming meeting.
Devise a proposal that address the following:
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- Present a four to five (4-5) page proposal recommending the team’s final decision based on the review of National Committee on
- Quality Assurance (NCQA), 2016-2017 health insurance plans rating that can be located directly at
- http://healthinsuranceratings.ncqa.org/2016/Default.aspx. The proposal must identify the following:
- Conduct a one (1) page analysis of the ACA and its future implications on managed care organizations
(in particularly in reference to reimbursement)
- Create a one (1) page checklist that will be utilized as a tool to review managed care contracts presented to the organization.
- A one year (1) financial analysis as a predictive measure/tool projecting the financial performance based
on the adoption of the selected health plan and reimbursement model [based on fictitious data and figures]
- Identify at minimum three (3) involved parties the team recommends as a contributing player in the review of
all managed care contracts under consideration. Briefly support your reasoning for each recommended person to
participate in the review.
- Share the team’s final review of the contract, Medical Center has received for consideration. In addition,
- provide a final recommendation as to the selection of the primary managed care organization. In addition, discuss
- whether the contract should or should not be accepted, and the logic for the recommendation. The contract template
- can be located directly at https://www.aaaai.org/Aaaai/media/MediaLibrary/PDF%20Documents/Practice%20Management/Office%20Operations/sample_managed_care_contract.pdf )
Resources:
Successfully Negotiating Managed Care Contracts: http://www.hfma.org/Content.aspx?id=16658
Managed Care Answer Guide: http://www.patientadvocate.org/requests/publications/Managed-Care.pdf
2013 MC Contract Evaluation Guidelines: http://www.acr.org/~/media/ACR/Documents/PDF/Economics/Managed%20Care/2013_CEGuidelines.pdf
Analyzing Managed Care Contracts: http://www.akrongeneral.org/portal/page/portal/AGMC_PAGEGROUP/practicemanagement/AnylzMgmtCrCntrcts.pdf
Managed Care Contracting Toolkit: https://www.glms.org/Content/User/Documents/PPAC/ManagedCareToolkitComplete.doc
Sample Managed Care Contract Template
: https://www.aaaai.org/Aaaai/media/MediaLibrary/PDF%20Documents/Practice%20Management/Office%20Operations/sample_managed_care_contract.pdf
