Managed care contract negotiations can be difficult to approach.
Before attempting one, you should have a comprehensive understanding of negotiated rates and payer mix, knowing the risk management issues related to your client population as well as development of a strategic book of services/products to address this. Additionally, you will need a close study of your processed claim history including denials. Contracts must also be analyzed well before they expire, because a managed care negotiation is not a quick process and will, more than likely, require multiple conversations.
Our managed care consultant team has expert experience with managed care contract analysis with adult as well as children services.
Individual contracts can be reviewed and recommendations offered regarding rates and next steps in provider negotiations. All teams and projects are tailored to your specific needs.
SAE is pleased to announce a lead expert in managed care contract analysis:
JOSEPH MARAFITO, MS
CONSULTANT ADOLESCENT, DISABILITY AND SUBSTANCE ABUSE
Over 20 years of progressive supervisory, program development and administrative experience in both the public and private sectors. Expertise in program evaluation, public policy, fiscal management, revenue enhancement, program development, regulatory issues, residential and community outpatient services. Worked with executive and legislative branches of government through policy committees and workgroups advising branch administrators on system development and policy related matters. Accomplished significant population reduction over a two-year period at the beginning of the deinstitutionalization movement in Connecticut, developed agency in CT that provided community based services and eventually the first supported living program in CT, co-wrote and negotiated substance abuse grants and transitioned adult residential program to adolescent residential and out-patient services.
Projects include environmental scan for Optimum Health; white papers regarding the inclusion of individuals with ID/D into managed care for long term services for Magellan; evaluation of the state of New Hampshire system’s quality assurance regulations, policies and procedures and an evaluation of a national for-profit company providing services within the ID/DD and behavioral health systems; evaluation of North Carolina MCO system of behavioral health children’s services with a corresponding analysis of the state and MCO’s regulatory systems for a pending lawsuit regarding children and families; research for systems development for children with co-occurring conditions; a multi-year project concerning a DOJ lawsuit in Texas (Steward Case) where we designed the program evaluation system, trained reviewers, analyzed reports and data and provided feedback on regulatory and community based services and the state service delivery system; consultation in the state of CT on regulatory impact of the behavioral health network for children and families and policy as well as same in the ID/DD regulatory arena; and clinical reviews for the implementation of Settlement Agreements.
If you would like to explore how we can help you in the managed care arena, feel free to reach us by phone at (212)-684-4480, or by emailing firstname.lastname@example.org.