Managed Care Organization (MCO) Team Project “Contracts Review”

You are the new CFO, of UMUC 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 addresses the following:

• 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.
•  Submit one (1) single Microsoft Word document  

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

Managed Care Contracts - Key Provisions for Providers  https://corporate.findlaw.com/law-library/managed-care-contracts-key-provisions-for-providers.html

National Council on Disability (2013).  Chapter 1. An Overview of Medicaid Managed Care.  https://www.ncd.gov/publications/2013/20130315/20130315_Ch1/

Tinsley, R. (1998, September/October).  Negotiating or renegotiating managed care contracts.. Medical Group Management Journal. pp. 66-71.  (In Week 4 Learning Resources)

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