ANALYZING & NEGOTIATING MANAGED CARE CONTRACTS

Analyzing & Negotiating

Tampa, FL - May 19-20 Denver, CO - Jul 23-24

Managed Care Contracts

Call 800.209.7263 to register by phone

Maria Todd’s nationally-renowned, two-day, hands-on workshop for Managed Analysts & Negotiators

Isn’t it time you came back for a continuing professional education refresher? Over 20,000 healthcare executives and professionals nationwide have attended this two-day workshop since it was first offered in 1993 -- some returned 4 times in the last twenty years! The only class in the nation to have been consistently rated on average 4.93/5.0 on all returned post-program evaluations by workshop participants!

Course Outline

Reformatted and Updated for 2014-2015 Contracting Framework • Key Payer Organizations and Payer Types • Direct-with-Employer Contracting • HMO, PPO, IPA, ACO, Medicare Advantage, Exchanges, Medicaid • Must-Know Payer Rules & Regulations • 10+ Payment models and P4P • Taming the Silent PPO Monster • Find and Eliminate These Perils Lurking in Most “All-Product” Agreements • Closing Costly Loopholes Building Your Strategies • Contract Analysis • Profitability • Community Access • Payer Stability • Controlling Access to Discounts • Steerage Formulas • Language Analysis

• • •

Preventing Technical Denials Preventing Unfair Refund Requests Strategies for Successful Appeals

Conducting Due Diligence • Market Share • Value Proposition • Assessing Negotiation Leverage • Strengths • Weaknesses • Opportunities • Threats • Deal breakers What to Do If Payers So “No” • Lockouts and Terminations • Unfair Business Practices • Antitrust Considerations • Monopsony vs Monopoly • Refusal to Deal • Network Adequacy • Subcontracting • Public Relations • Media Relations

Contract Performance • Payer Analysis • Payer Report Cards

• •

Patient Relations How to Get Regulators’ Attention

Negotiation Preparation Steps • Business Rules • Exit Strategies • Contract Analysis • Finding the “Gotchas” • Identifying Cost Drivers • Requesting Clarifications • Negotiating Changes • Alternative Language • Gathering Data • Implementing the Contract • Paperless Contract Management • Testing the Payment Terms Hands-on Analysis of a Integrated Network Contract • Identify language loopholes and cost escalators • Dealing with Potential Latent Ambiguities • Documenting Discussions • Formulate alternative language and push-backs Course Wrap Up, Evaluation & Dismissal

Why This Class? How will Your Organization Benefit?

Today’s healthcare providers in the USA have a dizzying array of more than 2000 managed care and other payer organizations with which to do business, including, but not limited to: • • • • • •

HMOs and PPOs Exchange Plans Medicare Advantage Plans Managed Medicaid Plans Case Managers Self-insured Employers and their TPAs

• • • • •

No matter what type of healthcare provider you are, or how long you’ve been working in healthcare, if you analyze and negotiate managed care or other reimbursement contracts contract with third-party payers of any kind, you will benefit from attending this class.

Unions Prison Health Services Workers’ Comp Insurers Travel Accident Insurers ACOs, IPAs, PHOs and OWAs

Before you take on the payers you must first have a contracting strategy that sets the business rules for your organization and gives you a set of rate parameters that will work to cover your care delivery and administrative costs and margins.

Each of these payer types has different rules, regulations, and contracting objectives. Each one has its own fee schedules, payment rules and regulations, and all kinds of ambiguities and loopholes that can catch providers by surprise and cause denials that can’t be overturned.

CLASS SIZE LIMITED TO ONLY 25 PARTICPANTS PER SESSION BRING HOME THESE SKILLS

WHO SHOULD ATTEND?

1.

•

Perform deeper due diligence on managed care organizations 2. Prevent technical denials 3. Appeal wrongfully-denied claims 4. Prevent unfair refund requests 5. Enhance profitability and competitiveness 6. Bring home lots of model revision language 7. Update your contracting and analysis skills 8. Network with other providers who are looking for similar solutions 9. Increase effectiveness at the negotiation table 10. Learn to initiate and manage amendments to bad contracts 11. Strengthen system and process improvement

• • • • • • • • • • • •

ACO Administrators and Key Physician Leaders Care Navigators Care Coordinators Directors of Nursing Social Workers Data Analysts Medical Directors Health System Directors and Managers Contract Negotiators Hospital Executives Multispecialty Group Executives Physicians Health Insurers

• • • • • • • •

Provider Relations Coordinators Physician Leaders Marketing and Social Media Coordinators Patient Engagement Strategists Physicians considering PCMH development Public Health and Health Promotion Specialists Consultants Investors

WORKSHOP LEADER

MARIA K TODD

Contracting strategy and organizational development (OD) for integrated health delivery systems has been a passion and a pursuit of our workshop leader since 1983. Maria Todd started her career in health administration in the multi-specialty group practice setting, and later designed and developed more than 150 IPAs, PHOs and MSOs during the Clinton Administration. In 1995, McGraw Hill and HFMA co-published her book, The Managed Care Contracting Handbook, and then in 1997, her book, title IPA, PHO, MSO Development Strategies was released. Both how-to books were written to help providers develop reimbursement strategies and design, plan and launch integrated health systems.

Each sold more than 4000 copies. Considering there are about 7500 licensed hospitals in the USA, that number is considered a smashing success. In 2009, the sequel to ththe Contracting Handbook was updated and in 2012, her book, Physician Integration and Alignment: IPA, PHO, MSO ACOs and Beyond, was published by CRC | Productivity Press Both are once again, breaking industry sales records. She’s been analyzing and negotiating managed care contracts and practicing organizational development as a facilitator since the 1980s.

In 2010, the US Patent and Trademark Office (USPTO) granted Maria Todd the registration of a new term of art, the Globally Integrated Health Delivery System® for her application of the integrated health system concept and operations to the medical tourism and health travel arena. She built the first and only globally integrated health delivery system which combined all the elements of ACO accountability, predictive modeling, case management, provider credentialing and privileging, quality, safety, clinical outcomes and patient satisfaction metrics, telehealth and telemedicine technology applications, electronic medical records, international cloud-based data and privacy security, and TPA operations for provider claims settlement and bill audit. To this, she added a fully-documented system to manage complex and specialized health travel logistics coordination to the mix.

Maria has professional work experience as an HMO Provider Contracting Manager, IPA Executive Director, Health Law Paralegal and Mediator, OR Nurse, Multi-Specialty Practice Administrator, Hospital & Surgicenter Administrator, and Care Navigator. As a professional speaker and trainer for various event sponsors, conference organizers, and trade associations, she has presented more educational programs (>2700) in managed care and integrated health delivery systems development than any other presenter in the world. She is also the author of 14 commercially-published handbooks, including: • • • •

Tampa, FL - May 19-20 Denver, CO - Jul 23-24 Call 800.209.7263 to register by phone TIMES: 9:00A - 4:30P CLASS SIZE MAXIMUM 25 Participants

The Managed Care Contracting Handbook, 2nd edition Physician Integration & Alignment: IPA, PHO, MSO, ACOs & Beyond The Physician Employment Contract Handbook, 2nd edition IPA, PHO, MSO Development Strategies

Analyzing & Negotiating

Managed Care Contracts

Maria Todd’s nationally-renowned, two-day, hands-on workshop for Managed Analysts & Negotiators Registration Fee:

$795 per person Discounts apply when two or more register together

DISCOUNTS If your Company’s name is found in the Corporate Discounts section, or if you are a subsidiary of one of those companies, then you are entitled to a $40 discount per registration. You can also receive a discounted per person rate when you register multiple persons at the same time. Call 800-209-7263 for code.

This discount cannot be combined with the Reserved Seat Program or In-House seminar offers.

Bring a laptop to class so you can participate in some of the hands-on exercises. Dress casual and comfortable.

REGISTRATION INCLUDES • Course materials on USB • Refreshment Breaks • Lunch • Attendance Certificate • One copy of The Managed Care Contracting Handbook, 2nd edition

We accept: MC VI AX DS TO REGISTER BY PHONE CALL

800.209.7263 PLEASE NOTE: Registration closes 7 days prior to class or upon sellout - whichever occurs first. Waiting lists will be started in the event we have cancellations.