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Atricle Dump - Cutting Out Managed Care Middleman Reduces Cuts Health Plan Costs
I've never worked for a boss I didn't like or respect. Sure, some were better than others, but I never considered quitting my job because of a bad boss. Unfortunately, many employees aren't so lucky. If your boss is a total butthead, someone you'll never get along with, admire or respect no matter how hard you try, there are a few things you can do. Wait. Is your boss close to retirement or promotion--or even better--termination? If so, try to bide your time and wait until that happy event happens. Bite your tongue. Keeping anger and frustration bottled up inside is not healthy, but neither is complaining about your boss at work. So if your family can tolerate it, vent at home instead. It'll make you feel better ev
Myth 4: Direct networks create more administrative burdens and higher costs. The truth is once direct networks are developed, the advantages of "owning" a network quickly outweigh "leasing" one from a managed care company. There are no recurring network access fees; less physician attrition; fewer employee complaints; simpler self-renewing contracts; better provider relationships; straightforward plan design features; and the ability to choose the best contractors for utilization review, case management, claims processing, and other administrative tasks. Managed care companies have failed to contain e
It’s been interesting to watch the (sometimes forced) assimilation of Generation Y into the Boomer-dominated workforce of the early 21st century. Surely no two generations working together have been so disparate…at least that’s what we’re led to believe, and to an extent it’s true. There are vast differences in the two generations’ values and beliefs.But I would suggest the computer is one element that brings the two together and, at another level, clearly defines one important difference in the two groups.First, let’s look at the Baby Boomers. They entered the work force, for the most part, devoid of computer knowledge. The earliest of the Boomers knew computers as something called Univac that filled a room, had lots of blinking lights and, finally, made wro
Myth 1: Employers cannot negotiate as good a deal with medical providers as can managed care companies. The truth is employers can often negotiate just as good a deal, or better. Providers welcome direct agreements for the very reason that they are not like conventional managed care contracts. Physicians have complained for years about adversarial agreements and poor reimbursements forced upon them by HMOs and PPOs. This negative perception has created a strong willingness among medical providers to do business directly with employers. These "win-win" agreements ultimately save employers money without shortchanging the providers. Unlike managed care companies, direct agreements disclose all contractual details so both employer and provider know the deal they're getting and nothing can be hidden by a middleman's "cut."
Myth 2: You need large numbers of employees to negotiate direct provider contracts. The truth is physicians and hospitals will often contract with employers for limited numbers of employees. When a direct agreement is fair and reimbursement terms are reasonable, providers quickly realize it's a smart business decision to work with employers in their own community. A local employer, regardless of size, represents an established group of existing lives as prospective patients, ready to use the direct network providers. Direct networks have been successfully developed in areas where the employer had as few as 30 employees.
Myth 3: Direct contracting won't work in areas where other PPO networks are available. The truth is doctors are sick of disadvantageous agreements and miserable reimbursements forced upon them by managed care companies. They actually welcome the opportunity to contract directly with employers. For many doctors, the very fact it's an agreement with the employer, and not a managed care company, is reason enough to participate in a direct network. A direct agreement establishes a true business relationship between provider and employer, one that promises the provider quicker reimbursements, better benefit payment levels, and easier access to the ultimate payer (the employer). It's also a gesture of good community relations for any physician, medical group, or hospital to demonstrate.
Myth 4: Direct networks create more administrative burdens and higher costs. The truth is once direct networks are developed, the advantages of "owning" a network quickly outweigh "leasing" one from a managed care company. There are no recurring network access fees; less physician attrition; fewer employee complaints; simpler self-renewing contracts; better provider relationships; straightforward plan design features; and the ability to choose the best contractors for utilization review, case management, claims processing, and other administrative tasks. Managed care companies have failed to contain em
Developing a long-term customer relationship is very similar to dating. How you grab a prospect's attention is critical. Advertising, direct mail, public relations, or a website may be the first step towards starting the relationship, but don't let your marketing effort be another tacky pick-up line. What you say and how you say it will determine whether the prospect will be interested in starting a relationship or respectfully decline your offer to have a drink.Getting the prospect to meet with you is only the first step in the relationship building process. Taking the relationship to the next level requires your marketing effort to make an impression that will create interest and have them call you the next day. However, it is not about tricking the prospect into being
Myth 2: You need large numbers of employees to negotiate direct provider contracts. The truth is physicians and hospitals will often contract with employers for limited numbers of employees. When a direct agreement is fair and reimbursement terms are reasonable, providers quickly realize it's a smart business decision to work with employers in their own community. A local employer, regardless of size, represents an established group of existing lives as prospective patients, ready to use the direct network providers. Direct networks have been successfully developed in areas where the employer had as few as 30 employees.
Myth 3: Direct contracting won't work in areas where other PPO networks are available. The truth is doctors are sick of disadvantageous agreements and miserable reimbursements forced upon them by managed care companies. They actually welcome the opportunity to contract directly with employers. For many doctors, the very fact it's an agreement with the employer, and not a managed care company, is reason enough to participate in a direct network. A direct agreement establishes a true business relationship between provider and employer, one that promises the provider quicker reimbursements, better benefit payment levels, and easier access to the ultimate payer (the employer). It's also a gesture of good community relations for any physician, medical group, or hospital to demonstrate.
Myth 4: Direct networks create more administrative burdens and higher costs. The truth is once direct networks are developed, the advantages of "owning" a network quickly outweigh "leasing" one from a managed care company. There are no recurring network access fees; less physician attrition; fewer employee complaints; simpler self-renewing contracts; better provider relationships; straightforward plan design features; and the ability to choose the best contractors for utilization review, case management, claims processing, and other administrative tasks. Managed care companies have failed to contain e
When thinking about the press release or free pr most companies may think, the document is just an obscure piece of the communication strategy that does not get much attention. However, in the world of today the press release can be one of the major communication documents that reach hundreds or even thousands of people searching the web today. Not only does the online press release get you valuable free pr it helps to boost the publics’ perception of your product or service and optimizes your website for better search engine rankings.We will explore some very easy ways to optimize your press release or free pr for maximum exposure on the web. If your company does not have a press kit, you can go here to find out more about setting up a press kit.Free pr ca
Myth 2: You need large numbers of employees to negotiate direct provider contracts. The truth is physicians and hospitals will often contract with employers for limited numbers of employees. When a direct agreement is fair and reimbursement terms are reasonable, providers quickly realize it's a smart business decision to work with employers in their own community. A local employer, regardless of size, represents an established group of existing lives as prospective patients, ready to use the direct network providers. Direct networks have been successfully developed in areas where the employer had as few as 30 employees.
Myth 3: Direct contracting won't work in areas where other PPO networks are available. The truth is doctors are sick of disadvantageous agreements and miserable reimbursements forced upon them by managed care companies. They actually welcome the opportunity to contract directly with employers. For many doctors, the very fact it's an agreement with the employer, and not a managed care company, is reason enough to participate in a direct network. A direct agreement establishes a true business relationship between provider and employer, one that promises the provider quicker reimbursements, better benefit payment levels, and easier access to the ultimate payer (the employer). It's also a gesture of good community relations for any physician, medical group, or hospital to demonstrate.
Myth 4: Direct networks create more administrative burdens and higher costs. The truth is once direct networks are developed, the advantages of "owning" a network quickly outweigh "leasing" one from a managed care company. There are no recurring network access fees; less physician attrition; fewer employee complaints; simpler self-renewing contracts; better provider relationships; straightforward plan design features; and the ability to choose the best contractors for utilization review, case management, claims processing, and other administrative tasks. Managed care companies have failed to contain e
During a coaching session I was doing this week we discovered that one of the problems the group I was working with was going through was that they were revealing too much information about the problems they saw, too early in the call. Over-divulging too much info is a cardinal sin of selling and here are some reasons why this is so.It can bore the audience. When you start to educate a customer with your technical findings too early when you haven't figured out a solution, the natural reactions that people have is one of trying to distance themselves from you. When you keep talking many customers just shut down and get bored. To make the information more compelling, you must always refer to your presentation when you will reveal the problem and the solution together.0 employees.
Myth 3: Direct contracting won't work in areas where other PPO networks are available. The truth is doctors are sick of disadvantageous agreements and miserable reimbursements forced upon them by managed care companies. They actually welcome the opportunity to contract directly with employers. For many doctors, the very fact it's an agreement with the employer, and not a managed care company, is reason enough to participate in a direct network. A direct agreement establishes a true business relationship between provider and employer, one that promises the provider quicker reimbursements, better benefit payment levels, and easier access to the ultimate payer (the employer). It's also a gesture of good community relations for any physician, medical group, or hospital to demonstrate.
Myth 4: Direct networks create more administrative burdens and higher costs. The truth is once direct networks are developed, the advantages of "owning" a network quickly outweigh "leasing" one from a managed care company. There are no recurring network access fees; less physician attrition; fewer employee complaints; simpler self-renewing contracts; better provider relationships; straightforward plan design features; and the ability to choose the best contractors for utilization review, case management, claims processing, and other administrative tasks. Managed care companies have failed to contain e
One of the most commonly overlooked opportunities in creating effective direct mail, is the real estate inside the envelope. Frequently, marketers will spend many hours crafting a perfect teaser line or developing a compelling intro to a letter only to stuff it into a default outer envelope.In fact, Nearly 3/4 of envelopes sent through the mail are 24lb white wove #10s. With that type of volume, you need to be able to break through the clutter. And techniques pertaining to the envelope is a great place to start. After all, it is the first thing your target will see. They say never to judge a book by it’s cover. The reality is people do anyways—and the envelope is the cover to your communication.Of course if money was no object, marketers would be printing with gold
Myth 4: Direct networks create more administrative burdens and higher costs. The truth is once direct networks are developed, the advantages of "owning" a network quickly outweigh "leasing" one from a managed care company. There are no recurring network access fees; less physician attrition; fewer employee complaints; simpler self-renewing contracts; better provider relationships; straightforward plan design features; and the ability to choose the best contractors for utilization review, case management, claims processing, and other administrative tasks. Managed care companies have failed to contain employer medical cost increases, despite all their so-called network management efforts. Ironically, and coincidentally, managed care industry profits are at an all-time high while employers continue to suffer.
Myth 5: Direct contracting exposes employers to greater liability. The truth is direct contracting poses no greater risk of litigation than any other benefit program component and may actually offer greater protection against it. Direct contracting is intended only for self-insured employers whose plans are governed by ERISA, which offers built-in protection against liability. ERISA preempts state tort laws and limits the employee's ability to hold an ERISA plan liable for malpractice under state laws, which govern malpractice, not ERISA. Because direct provider agreements state the employer is not providing/directing medical care and has no role whatsoever in any medical decision, the protection offered by ERISA's preemption is safely maintained.
Myth 6: Managed care companies can't (or won't) process claims for direct networks. The truth is that processing claims and administering benefits for employer-owned provider networks are well within the technical capabilities of managed care companies. Their feigned inability to process direct network claims is one of many ways that managed care companies hold their employer-clients hostage in networks that are owned, leased, or arranged by the managed care companies themselves. If an existing managed care company cannot or will not administer direct network claims, there are plenty of third party administrators (TPAs) than can handle it, usually at a lower cost per employee. For employers that want direct networks in select locations (but want to keep commercial networks elsewhere), using a TPA is a convenient and cost-effective way to get the job done.
Myth 7: Managed care companies do a better job containing costs and saving employers money. If that was true, employer medical plan costs would be falling instead of rising. The truth is employers who have implemented direct provider contracting are experiencing lower costs and higher savings. One national employer with 20,000 employees has used direct networks to keep their health plan cost trend flat for the past five years. Another major employer reduced its health plan costs by more than 20% without reducing benefits or shifting costs to employees.
Bottom Line: Cutting out the managed care middleman and contracting directly with medical providers can help savvy employers reduce benefit costs and regain control over their corporate health care plans.
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