Cost Control and Beyond: Best Practices for Value Based Health Plan Contract Management

The healthcare sector is experiencing a rise in consumerism, making patient loyalty even more important to health plans. Otherwise, members may opt to switch to a new network or change their networks. To deliver value-based patient care, healthcare providers, like you, must attract and retain the best providers in the network. This can be done through modern contract management for healthcare.

What is Health Plan Contract Management Software?

Delivering a value-based model begins with having a robust provider contracting management solution. But, what exactly is a healthcare contract management system?

A health plan contract management software is a solution that enables health plans to manage and oversee contracts between provider organizations and hospital systems. These contracts can cover a wide scope of agreements, value-based, fee-for-service (FFS), capitation contracts, and per diem.

What Typically Slows Down the Provider Contract Process?

With multiple types of contracts that health plans are required to manage simultaneously, the process gets cumbersome and error-prone. Confusing terms and the lack of clarity make provider contracts seem like being stuck in a foggy maze, with no clear direction and no transparency. Several factors contribute to slowing down healthcare providers in contract management, such as navigating complex negotiations, ensuring regulatory compliance, conducting thorough reviews by financial and legal teams, gathering documentation requirements, and more.

How a Streamlined Provider Contract Management Solution Can Help Especially in Value-based Contracts?

With provider contracts becoming more complex, the right technology becomes essential for health plans to effectively manage them. With tens of thousands of contracts, a streamlined payer contract management system provides a digitized and centralized foundation to handle various tasks linked with contract negotiation, creation, execution, and management. A modern healthcare contract management system can ensure contracts are comprehended well and comply with predefined standards.

• Efficiency and Cost Control: A simplified and automated contract workflow enables healthcare providers to reduce the time and cost of negotiating and reviewing contracts. By emphasizing outcomes rather than services, value-based contracts help minimize unnecessary procedures and hospitalizations, thus controlling healthcare costs
• Patient-centered Approach: Contracts that focus on achieving better patient outcomes lead to higher quality care. A streamlined contract management workflow promotes preventive care and chronic disease management, reducing costly acute care episodes. The solution enables providers to adopt a more holistic approach to patient care, considering all aspects of a patient’s health rather than just treating individual conditions
• Data-driven Decision: With a payer contract management system that leverages data analytics, providers’ contracts can monitor and improve performance, identify gaps in care, and support evidence-based decision-making. Data can manage population health, identify high-risk patients, and intervene early to prevent complications
• Provider Collaboration: A healthcare contract management software fosters collaboration between health plans and providers, leading to more integrated and coordinated care delivery
• Regulatory and Market Trends: A healthcare contract management system aligns trends in healthcare policy and regulation to promote value over volume, such as those advocated by the Centers for Medicare and Medicaid Services (CMS)
• Accountability and Performance: With an ideal provider contract management software, providers can share the financial risks with health plans, aligning incentives for both parties to focus on cost-effective and high-quality care. The system ensures that providers are held accountable to specific performance metrics, ensuring continuous improvement in care delivery
• Sustainability: Value-based contracts promote the financial sustainability of health plans by focusing on long-term outcomes and cost savings. A robust healthcare contract management software can be scaled and adapted to different populations and settings, making it a versatile tool across diverse healthcare environments

In Conclusion

In conclusion, a modern healthcare contract management system is significant for navigating through the current healthcare complexities. Providers can adopt a patient-centric approach by streamlining the contract management workflow. This approach enables providers to control costs, maximize efficiency, make data-driven decisions, ensure regulatory compliance, and improve the quality of care.