Contract Negotiations

 

E Health MSO provides the negotiation of contracts services to its customers with HMOs and PPOs. The contracts we negotiates on behalf of our clients usually involve a few level of financial risk sharing between the health plan and the IPA/PHO.

The negotiation of health plan contracts involves assessment of various risk models to determine which would be most beneficial for our specific client. Doing so involves analyzing historical data for IPA/PHO physicians, as well as making projections of future performance.

The major issues usually addressed by us in an IPA/PHO contract are as follows:

  • Withhold levels on PCPs, specialists and hospitals
  • Funding levels for the specialty, hospital and pharmacy funds
  • Limits on financial risk i.e. Upside and downside
  • Physicians Fee schedule
  • Hospital compensation
  • Obligation of health plans to provide reports and claims data
  • Restrictions on use of IPA/PHO physicians in health plan marketing
  • Amendments
  • Liability insurance
  • Termination