This e-book’s goal is to offer medical practice leadership teams practical guidance on navigating the shift from volume-based to value-based managed care contractual relationships. Medical practices – both independent and affiliated – that understand how their organization can and should position themselves for the future will have a significant advantage over the competition.
Honestly identifying where you are and defining where you want to be begins with developing a clear understanding of national and local market dynamics, identifying potential arrangements within your local market and applying those factors to your organization’s goals. This exercise can ultimately inform your value proposition, which becomes the cornerstone of your managed care contracting strategy.
The e-book will cover in detail the most common alternative payment models and what your practice should do to prepare for this transition.
Models detailed include:
- Pay for performance
- Bundled payments
- Shared savings
Doral Davis-Jacobsen, MBA, FACMPE, is a Partner at Prosper Beyond LLC, a specialized healthcare consulting firm in Asheville, N.C. Doral is a seasoned healthcare consultant with more than 20 years of experience serving healthcare providers ranging from solo practitioners to large academic medical centers. She is a popular speaker and author, always looking around the corner to help her clients prepare for what's next. Doral is known for assisting practices with next generation managed care contract negotiations, payment reform and revenue cycle. She is a Fellow in the American College of Medical Practice Executives. Doral serves as the Chair for the North Carolina MGMA Payer Contracting Committee 2021. She has written numerous articles on medical practice revenue cycle, managed care contracting and payment reform and is a frequent speaker at national, regional and local healthcare forums. Doral is theco-author of MGMA's book Transitioning to Alternative Payment Models: A Guide to Next Generation Managed Care Contracting, published in October 2016.
Nanci Robertson is a healthcare consultant specializing in managed care contracting. She has 30 years’ experience working in the healthcare field, with emphasis on negotiating managed care contracts on behalf of physicians, independent practice associations and ancillary providers.
Before launching Robertson Consulting, Inc., in 2000, Nanci worked in several clinical positions as a registered nurse. Her managed care experience includes managing and directing the health services, provider relations and contracting departments of Cigna Healthcare of Colorado, Inc. Additionally, Robertson served as the site administrator for Phy-Cor, where she was responsible for implementing full-risk hospital and physician contracts for Medicare and commercial risk products.
Most recently, Robertson spends her time putting together the puzzle pieces of healthcare reform. Her primary goal is to assist clients in visualizing how they fit into the big picture in a rapidly changing environment.
Chapter 1 Introduction
Chapter 2 Triple Aim
Chapter 3 Narrow Networks
Chapter 4 Patient Liability
Chapter 5 Transparency
Chapter 6 Quality Metrics
Chapter 7 Connecting the Dots
Chapter 8 Fee-for-Service
Chapter 9 Pay for Performance
Chapter 10 Bundled Payments
Chapter 11 Shared Savings
Chapter 12 Capitation
Chapter 13 Setting up to Succeed
Chapter 14 Conclusion
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