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Biomedical subjects

J E Belt

Publications and source records attributed to J E Belt.

6 recordsLinked to original sources
PubMed2000

Managed care strategic planning: the reality of uncertainty.

The unpredictable future of the managed care industry has led to strategic planning paralysis in some organizations. The lack of a strategic plan can be damaging to an organization's long-term viability. In developing a managed care strategic plan, an organization should have a basic understanding of its environment and its ability to make changes as indicated by its structure and information system capabilities. If the organization is both strong and flexible in these two areas, it is well positioned to thrive in the turbulent managed care environment. Strategic plans need to consider alternate futures, reinforce the organization's vision, support the organization's long-term financial viability, and incorporate the reality of the industry's uncertain future.

Information Systems↗
PubMed1998

Conducting a managed care contract review.

Healthcare providers traditionally focus on price when negotiating managed care contracts, but other important contract terms can affect the degree of legal, strategic, and financial risk a provider bears. In addition to having a review of all contracts by legal counsel, providers should conduct a separate business review of the contract terms, from making sure terminology and references are clearly defined or explained to assessing the details of the dispute resolution procedures. Providers should fully understand--and possibly refuse--requirements that could result in additional costs.

Contract Services↗
PubMed1998

Combating silent PPOs.

A silent PPO is a contracting entity that negotiates discounts with providers but sells access to the discounts to other, nonrelated parties after services are provided to individuals covered by the nonrelated parties' insurance policies. Healthcare financial managers should be alert to the presence of silent PPOs when entering into contract negotiations. To combat silent PPOs, a two-pronged approach--prevention and detection--is advisable. Factors to consider include appropriate contract language stating that all clients with access to the discounts have a contract with the PPO, presence of the PPO's logo on a patient's insurance card, and the PPO's willingness to limit the number of providers in its network. Warning signs that indicate the presence of a silent PPO include a high volume of retroactive reclassifications, single employers taking discounts from multiple PPO networks, or payments for services provided to single individuals coming from multiple PPO networks.

Contract Services↗
PubMed1997

Achieving incremental volume increases.

Despite provider assumptions that managed care contracts will yield incremental increases in patient volume, there are no guarantees that volume increases will be realized. Providers can improve the likelihood that incremental volume increases will be achieved, however, by including certain provisions in managed care contracts related to volume-based discounts, limitations on network size and composition, access to physicians, provider directory listings, patient financial incentives, service scope/carve-outs, and participation in all service products offered by the managed care organization. Negotiating such provisions may be difficult, but providers and managed care organizations that reach agreement on these provisions gain mutual understanding and frequently can form more successful relationships.

Community Networks↗
PubMed1997

Is the Medicare SELECT program a stepping-stone to managed care?

Under the Omnibus Budget Reconciliation Act of 1990, Medicare SELECT programs and standardized Medigap policies were made available to senior citizens. Medigap policies offer coverage to supplement Medicare benefits, and the SELECT program offers a PPO-like product that offers reduced premiums if the beneficiaries agree to enroll in a preferred network. HCFA's recent evaluation of the SELECT program indicated a variable success rate in enrollment and cost-effectiveness. Providers will need to develop a strategic position concerning their participation in the Medicare SELECT program, which should include knowledge of SELECT program incentives, economics of the SELECT contract, and Medicare market position. In addition, providers should assess whether the SELECT program is consistent with strategies to transition Medicare populations into managed care.

Aged↗