Managed Care Contracting

In the marketplace of managed care, providers’ ability to deliver quality health care is quite often a product of the contracts they secure with the major payers, private and public. Assuring those contracts are fair, effective, and profitable for its provider clients has been the guiding principle for Strategic Health Care’s Managed Care Contracting practice.

Since 1996, Strategic Health Care’s Managed Care team has been successful in finalizing competitive contracts with all of the major payers in the state of Ohio as well as many of the regional payers and preferred provider organizations on behalf of an array of clients that have included hospitals, medical transportation, home care agencies, infusion companies, home medical equipment organizations, and hospices. Keenly aware that the best way for providers to achieve the leverage that translates to strong contracts is through combining forces, the Managed Care Contracting Division has also taken an active role in creating and managing networks of health care providers, and guiding their operations.

Strategic Health Care’s Managed Care Contracting services include:

  • Researching target markets;
  • Segmenting and prioritizing third-party payers based on size, geographic compatibility, and other established criteria;
  • Completing Requests for Proposals (RFPs) under the client’s direction;
  • Developing data in support of contract objectives, and establishing a database with pertinent contracting information (i.e., credentialing file);
  • Conducting in-depth contract reviews;
  • Managing contract negotiations and implementing the final agreement reached between parties;
  • Assisting clients with billing issues and contract updates;
  • Developing and performing in-service education for the client and for all contracted insurers for the purpose of increasing referrals to client; and
  • Creating member protocols for working effectively with each of the managed care organizations with which the client has contracts.

To learn more, please contact Carolyn Roten, Senior Vice President of Managed Care Contracting and Network Development, at Carolyn.Roten@shcare.net.