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Managed Care Contracts

The Professional Association of Specialty Physicians (PASP) has hired you as the membership manager. PASP has been incorporated for 25 years and during that time has grown from a membership of 100 physicians and one staff member to a membership of 1000 physicians and four staff members. The other staff members include an executive director and a controller who both have recently been hired.

The PASP board of directors wants to have a membership growth of 10% within the next year while retaining current members. Your position was newly created to accomplish this.

PASP is a physician specialty association and represents another membership fee that physicians must choose to pay because membership is voluntary and does not affect their relicensure. Physicians need to feel they are getting a good return on their investment both in joining and maintaining their membership because of issues of increasing competition from other specialists, challenges in getting reimbursement for services rendered, and managed care contracts that keep them very busy with the increase of the number of patients they must see.

Assignment:

Managed care has had a profound impact on the way healthcare is delivered and paid for in the U.S. The physician members of PASP will be significantly impacted by managed care. Any membership marketing pieces that PASP creates must reflect that PASP understands the challenges that managed care poses for its members. PASP should also be able to identify ways that members of PASP can get help in meeting these challenges. You believe that specialty physicians just leaving residency and setting up their practices is one possible market for new members. You have compiled a list of these physicians and will e-mail them a link asking that they accept a free 8-week e-mail subscription of a weekly electronic "tip of the week" to help increase their awareness of key terms used by managed care organizations.

Identify eight managed care contracting terms and write a brief definition of each term. Remember to cite all sources and be sure to write each definition using your own words.

Solution Preview

Hi,

Interesting assignment! Let's take a closer look. I also attached two other resources for extra reading.

1. Identify eight managed care contracting terms and write a brief definition of each term. Remember to cite all sources and be sure to write each definition using your own words.

Managed Care is a system of health care that combines delivery and payment; and influences utilization of services, by employing management techniques designed to promote the delivery of cost-effective health care. The contract between a physician or other health care professional and a managed care organization (MCO) such as a provider-sponsored network, integrated delivery system, health maintenance organization, or other health care plan, is the fundamental document which frames, defines and governs their relationship. Contractual provisions can affect payment, office organization, practices and procedures, and confidential records as well as clinical decision-making (http://library.findlaw.com/2004/Sep/19/133573.html).

There are many managed care contracting terms, so let's look at TEN managed care contracting terms for ...

Solution Summary

The Professional Association of Specialty Physicians (PASP) has hired you as the membership manager. This solution identifies eight managed care contracting terms and provides a brief definition of each term. Supplemented with definitions of many other managed care terms and an article on managed care contracts. All sources are cited.

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