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Seminar:
Managed Care Contracting
and Service Delivery

A three hour workshop designed to enable health care providers and networks to negotiate and implement more advantageous contracts and services with managed care plans.

Your mailbox must be full of information pertaining to managed care contracting seminars and techniques. Our program has distinct advantages over many others in that:

  1. We come to you. As many 40 people can participate over a three hour period.
  2. By providing it in your locality, we increase the opportunity for all levels of management staff as well as CEOs and CFOs to acquaint themselves with managed care concepts. This is an extension of staff development or CQI which brings pivotal leadership in organizations more directly into the managed care process. It leads to more effective development of managed care services in your organization.
  3. Contracts, models and data are customized to your locality. This program cuts through the smoke and discusses actual fees, capitation rates, and premiums.
  4. The cost of our program is a fraction of national workshops held outside of your area.

HMS Associates, a health care consulting firm that specializes in health care network development and managed care partnerships and contracting, is a Buffalo based firm founded in 1990. HMS Associates is offering this managed care session to providers or provider networks to strengthen their negotiation capacities with managed care plans and deliver managed care services that reflect their community's needs and interests.

The principal presenters are Gregory Bonk, President, and Rhonda Rosley, Managed Care Consultant, HMS Associates. Mr. Bonk and Ms. Rosley have extensive experience in New York State and Wisconsin pertaining to network development, managed care analyses, plan development and contract negotiation, and the development of urban and rural health network managed care responses. They have been involved in Medicaid and commercial managed care initiatives ranging from 500 to 130,000 subscribers and $250K in partial capitation fees to $100M in premiums. Clients include hospitals, clinics, government, and group practices.

Who Can Benefit ?

CEOs, CFOs and department heads
Boards of Directors or Trustees
Physicians
Private practitioners
Managed care team members
Members of health care networks
Behavioral health service providers
Practice plan administrators

What You'll Receive

Components of the Session Include:

  1. Discussion of key managed care concept, such as the often over looked distinction between subscribers and users.
  2. Managed care contracts tips, strategies, and techniques.
  3. Numerous capitation models pertaining to acute care, private physician practice, long term care, and special needs psychiatric populations, and
  4. How-to-worksheets that organizations can use to identify their cost competitive position in managed care plans.

Participants in this workshop will receive over 160 pages of information, which includes basic, essential tools required for contract negotiation such as:

  1. Current Procedural Terminology (CPT) structure and fee code for your particular geographic area - we utilize a system which has regional adjustments for 15 areas in New York State. This document is over 80 pages long and contains references for 9,800 codes and a sense of what constitutes a usual and customary charge.
  2. Glossary of key managed care terms.
  3. Ready reference to contract negotiation tips.
  4. Series of exhibits which displays extensive statistical material on how capitation rates are derived which is related to your particular area of the state.

Contractual Tip -
Compensation

The plan must provide documentation showing their withhold analysis schedules for your service for prior years.
Require year-end withhold reconciliation to end no later than the 1st quarter after the close of the contract year.

Capitation Model -
Commercial/Medicaid

 

Sample Agenda

1. 1:30 p.m. Introduction of Presenters and Attendees

2. 1:40 p.m. Purpose of the Session

3. 1:45 p.m. Concepts/Definitions

4. 2:00 p.m. Contract Components

5. 2:25 p.m. Capitation Models and Applications

- Commercial/Medicaid
- Special Needs Psychiatric

...... 3:15 - 3:30 p.m. REFRESHMENT BREAK ......

- Physician/Clinic/Partial Caps
- Long Term Care

6. 4:30 p.m. Conclusion

Materials:

(Approximately 160 pages)

Attendees at Managed Care Sessions have said:

"Information presented is thorough and relevant. Senior management, by and large, department heads at the hospital, should have been in attendance. They are the front line managed care administrators and would clearly benefit from a detailed yet relevant discussion of managed care contracting processes, fees and organizational informational needs."



"I never thought we had a chance to negotiate anything with a managed care company. It was their way or the highway. The points you have raised are going to be very useful in future of contracting exchanges."



"This three hour session removes the smoke and mirrors. It summarizes the real managed care dilemma - it's all in the details. The contractual tips, model capitation formulas and worksheets show specifically how providers can assess wins or losses."



"General Managed Care Plan did not mention that capitation fees are not all inclusive and that some services are still reimbursed on a fee-for-service basis."



"Very good for both managed care veterans and newcomers. We review about five contract offers a month. We're going to turn the tips and techniques into our own internal checklist."

Sample Fees

by Number of Registrants or Organizations

Registrants:

Minimum 12 at $125 per person - $1,500
Next 8 at $100 per person - $2,300
Next 10 at $85 per person - $3,150
Next 10 at $70 per person - $3,850
Additional persons at $50 per person
up to a maximum total of 70 people.

Organization/Agency:

Fees are subject to change. Travel and meeting costs are additional.


You are invited to obtain a complimentary set of sample managed care session materials

Please print and complete the following form and send it to HMS.

Yes, I would like to review sample materials from the managed care session .

Your Name: _____________________________

Title: ___________________________________

Professional Discipline: ____________________

Organization: ____________________________

_______________________________________

_______________________________________

Address: ________________________________

City: ___________________________________

State: _____________________ Zip: _________

Phone: _________________________________

Fax: ___________________________________

E-mail: _________________________________

Internet: ________________________________

Send form to:

HMS AssociatesSuite B, Box 3742280 Millersport HighwayGetzville, NY 14068
Tel. (716) 688 - 8448Fax (716) 688 - 0395Toll Free (877) 889-6519


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Publications

Multi-organizational Networks

New - Principles of Rural Health Network Development and Management, January, 2000

This publication is an asset for both evolving and mature multi-organizational health care networks and can be downloaded at no charge from the Academy for Health Services Research and Health Policy website. See Recent News

Rural Health Network Development: Experiences, Lessons Learned, and Strategies - For health care providers, government, network administration - Actual network experiences, successes and failures, what worked and what did not work, steps to network development. 1995.
73 Pages - $39.95

Health Network Development Handbook - For health care providers, local and state government, network administration - How-to-resolve conflict/negotiate network landscape, alternative planning processes guides and data sources for NYS. 1996.
42 Pages - $49.95 on diskette - $124.95

Community Networking: Keeping Kids Out of Trouble - For Persons In Need Supervision /Juvenile Delinquency programs, probation, social services, law enforcement, schools - Collaboration among these four key groups, how to be organized yet not co-opted by other organizations, assessments, collaborative models, key informant surveys and findings. 1994.
45 Pages - $49.95

Critical Questions for Network Members - For health care providers and boards of directors - Preparatory work which should be undertaken by organizations contemplating network and alliance development. 1996.
8 Pages - 20 copies - $19.95


Analytical Series

 New - Local Health Data Library, June 1, 2001

Community Health Profiles - Mortality and Reproductive Health Problem Identification System - Contains charts, maps, and tables which pinpoint health status problems by community, minor civil division or census tract level and relate data to regional, statewide, and Healthy people 2000 "norms" - Useful for hospital community service plans, county municipal health assessments and community health assessments, multi-organizational health care provider planning purposes. Data 1992 - 93.
Prices start at $449.95

Mental Disabilities Managed Care Profiles and Capitation Analyses - Medicaid utilization data by NYS County for selected mental disability indicators. Useful for providers, local government, special needs plans for forecasting service utilization and premiums by service type, severity and county or county groups. Data 1983 - 93.
Prices start at $250.00

Managed Care Contracting and Service Development - Definitions of key managed care concepts; contractual concepts and tips and techniques; 9,800 CPT Fee Schedule, adjusted; Capitation models, Capitation worksheets. For physicians, health care administration, boards of directors, managed care provider networks, excellent for staff development/CQI. 1996.
160 Pages with fees on diskette - $345.95
On-site workshops for 40 attendees also available.

PINS/JD Legal Processes Guide - Compendium of relevant New York State Family Court statutes with commentary and legal processes flow charts - For Persons In Need Supervision /Juvenile Delinquency programs, probation, social services, law enforcement, schools. 1996.
35 Pages - $69.95

Please circle each item you order above and add $4.50 each for shipping and handling for each item. New York State orders please add 8% sales tax. (U.S. $ only. No credit cards.) Call for info. on E or F or discounts on multiple copies.


TOTAL AMOUNT: ___________

Check Enclosed Bill me

Your Name: _____________________________

Title: ___________________________________

Organization: ____________________________

_______________________________________

_______________________________________

Address: ________________________________

City: ___________________________________

State: _____________________ Zip: _________

Phone: _________________________________

Fax: ___________________________________

E-mail: ________________________________

Internet: _______________________________

Signature: ______________________________


I do not wish to order but please send me other information on new publications.

Send order form to:

HMS AssociatesSuite B, Box 3742280 Millersport HighwayGetzville, NY 14068
Tel. (716) 688 - 8448Fax (716) 688 - 0395Toll Free (877) 889-6519

E-mail: Consulthms@aol.com


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