Physician Practice Managed Care Contracting
Ethos Partners works with medical group practices to assess and advise them about their overall managed care strategy and contracting.
We consult with physicians to ensure that they are realizing reimbursement that is appropriate for their respective market, region and practice.
We have extensive experience with varied forms of reimbursement utilized by managed care companies ranging from capitation, discounted fee-for-service, DRG-based fees, percentage of premium and per diem payments.
As a result we are able to advise and/or negotiate terms and reimbursement levels for group practices that are in line with the level of service provided to a managed care company’s membership.
In this evaluative and negotiation process, Ethos will work to maximize physician reimbursement from managed care companies using:
- Proprietary analytic tools to assess payor agreements and reimbursement analyses
- Assessment tools that allow our clients to assess performance relative to key terms in their managed care agreements
- Pay-for-Performance (P4P) opportunities as leverage with managed care companies to promote steerage
- Trends in consumer-directed healthcare to help prepare policies and procedures to deal with patients with Health Savings Accounts (HSAs) and/or high deductible plans