Question

Lesson 3: Managed Care Reimbursement Structures

Activity 3: MCO Contracts (100 points)

As a health care administrator, you must be able to determine problems that may arise in contracts formed with Managed Care Organizations. Using articles in ProQuest or reputable Web sites, locate and describe at least ten (10) contract issues that could cause problems from the hospital’s (provider’s) perspective. You must use at least two (2) sources. Your paper should follow APA guidelines and include a bibliography. (100 points) (A 3-page response is required.)

Answer 1

Due to increased health expenditures make serious problem for the population..most of the peoples are uninsured and not afford to buy health insurance..Managed care in the commercial price where medicaid changes happen..Medicaid reality of limited provider access even for fee-for - service medicaid..Managed care affects plan-hospital contracting and hospital prices..Hospital competition shifted from a physician/patient driven to payer/plan driven phenomenon..Purchasers were so sensitive to insurance premium increase than individual consumers because they pay large portion of the cost..
They have plans for better contracts with providers for lower payment rates..Serious contract disputes in the country have trade literature..Hospitals have been able to secure payments rates increase and influence other contract..there are variation among markets in the hospital sector-hospital negotiating leverage increased more with less dramatically..The more percent with hospital total patient days included the greater leverage plan pays higher prices..Plans pay higher prices if the hospital market is less competitive..Higher hospital occupancy rates results more prices..
Many health care organization make their power in local markets assess the nations..There is impact on health management organization penetration and selective contracting on hospital prices..so when HMO enrollment and hospital prices with contract decreased..Providers networks increased increased and hospital prices have increased..Hospital markets leads to higher prices especially in non profit hospitals..hospitals with higher prices rates although managed care can not confounding factors,it includes rising hospital costs..Physicians have link with patient and consumers so their hospital dealing in contract make more critical..And also there is lack of hospital staff shortage or location for geographic submarkets increase hospital market power..There is less reimbursement rates from private and public payers when costs are increasing..Due to hospital increased pressure,it make high premium to employers it make them into more burden..Plan-providers contract among managed care organizations for policy makers and consumers need more implications..