Managed Care Contracts
In addition to employment agreements, healthcare providers and practitioners have responded to the concept of “managed competition” by moving towards managed care and forming alliances which integrate hospitals and physicians through corporate structures. These range from simple contracting entities, such as independent practice associations, to foundations, which actually acquire physicians’ practices and employ them. These structures are generally designed to maintain access and provide cost-efficient and high quality service through consolidation of the various components of hospital and professional services. Regardless of the particular form or structure used, success is generally determined by how well the healthcare providers involved assure and document their quality of care, manage their utilization, and control their costs.
Allen, McCain & O’Mahony, P.C. assists physicians, hospitals and other healthcare clients in pursuing and entering into managed care contracts with:
- Health Plans
- Health Maintenance Organizations (“HMOs”)
- Preferred Provider Organizations (“PPOs”)
- Various Other Forms of Managed Care Organizations (“MCOs”)
These contracts, while potentially expanding the providers' patient base, require the provider to evaluate the risk assumed for the care provided to the MCO's enrollees. Whether contracting through a provider-sponsored network/integrated delivery system or individually, the provider needs to understand the conditions of this risk assumption and the relationship created with each MCO through contract.
