Strategic Assessment of Hospital Managed Care Market
In some markets, the power has swung so heavily to a given payor that the hospital is suffering financially,
and is unable to affect positive change with that payor. In these situations, it is necessary for the facility to
develop and implement a strategy that over time will balance the playing field in a way that allows the
hospital to improve its operating net revenue.
Managed Care can assist in the development and execution of that strategy in a number of ways:
■ Assist the facility in developing a "current state of
managed care" in their local market to include key
payors in place, contracts that the hospital is not a
party to that could affect volume, and market share
held by hospital. In addition, QHR can assist the
hospital in the identification of specific payors that
could enter the market with assistance from the
hospital, and have the presence to move fully insured
books of business.
■ Assist the facility in intelligence gathering with the
broker community to determine where they stand as
a group with the current situation, and how the hospital
might collaborate with them to bring other alternatives
to the local employer and individual plan markets.
■ Assist the facility in surveying the employer base
to determine their needs and perceptions, and their
willingness to directly contract with the hospital and
physician providers. QHR can suggest approaches
that will build a relationship with local employers that
encourages them to make changes in their choice of
third party payors and fully insured options. | ■ Assist the facility in contract negotiations
with new options for the local market.
■ As appropriate, assist the hospital in determining
which plans appear open to operating as a partner
with the hospital, and terminating those contracts
where they are not willing to work in a constructive
fashion with the local facility.
■ Assist the facility in the need and viability of an
integrated delivery system as an alternative to the
current situation. If developed as a strategy, assist
the facility in the development of the network as a
viable entity. |
For more information on QHR Patient Financial Services, contact:
Devika Kumar, Practice Leader, (800) 233-1470 ext. 4563.
 | © 2008 QHR
105 Continental Place | Brentwood TN 37027 | 1-800-233-1470 | | | | |  |
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