5 Tools to Power Your Managed Care Contracting Team

Copyright 9.23.2014: Scientific Cowboys – Author: Nancy C Everitt, PMP

 

Efficiency is doing things right; effectiveness is doing the right things.

Peter F. Drucker

Providing your team with the right tools so that they can accomplish the “right” things is a game changer.

Team HEOPS has compiled 5 Tools that you may already have or may want to consider creating to help power your Managed Care Contracting Team.

 

  1. Contract Language Guidelines
  2. Key Infographics
  3. Voicemail and Call Templates
  4. Standardized Pitch Decks
  5. Financial Guard Rails

 

Contract Language Guidelines

My favorite approach to contract language guidelines is one of logic and speed.

Lag is one of the deal killers in negotiations, negotiators need to be prepared and minimize lag on responses. A trip to legal and a two week wait does nothing to speed deal closure. Good, concise Contract Language Manuals are invaluable for a high performing contracting team.

1. What Cannot Be Changed: Federal, State or other Regulatory requirements and flag these clauses with a requirement symbol and a citation link.

2. What Can Be Changed With Approval: Flag key operational clauses that can be changed ONLY in specific situations with Management Approval.

3. What Can Be Changed with Alternative Language:

  1. Over the last few decades I see the same requests time and time again that do not require legal intervention.
  2. Effective organizations provide several alternate language provisions that negotiators can utilize along with guidance and explanation of organizational impact. This approach speeds the process and allows the negotiators to move forward.

 

Key Infographics

It’s a brave new world. Don’t be afraid to communicate visually with your audience through clever infographics to show process, statistics and impact.

Good areas for infographics include:

  • Pharmacy and Medication Adherence with Impact
  • Network Participation – Value Proposition and Plan Stats
  • Credentialing
  • Claims Process, Stats and Timing

 

Voicemail and Call Templates

If 70% of your calls were destined to end in voicemail, would you practice leaving a compelling message?

It’s true; approximately 70% of your outbound calls will end in a voicemail message.

This is a common point of failure. Voicemail messages are generally ineffective or may even be polarizing thereby ensuring no return call.

  • Take the time to create a set of approved voicemail templates targeted at no more than 30 seconds with specific and mindful goals.
  • By increasing your return call rate you can enhance effectiveness by 50% or more.
  • Think about how much this will help all of your team, new and existing.

 

Standardized Pitch Decks

Sounds a bit medieval, however I am just referring to standardized presentations or videos that resonate with your target audience. Food for thought, the story you wish to tell and the story they want to hear are not always the same.

A few ideas:

  • Organizational overview.  What’s your core and why would someone be interested in partnering with you. Be inspiring, real and visionary.
  • Provider Participation. Same concept, ensure that targeted providers can understand the value proposition and a high level process for contracting, claims payment and credentialing.

 

Financial Guard Rails and Methodology

Ensure that your contracting team understands why pricing and reimbursement is constructed the way that it is and how your claims system can/cannot execute.

  • Work with Finance and empower your team to negotiate within x and y ranges with approvals on outliers.
  • Explain most common scenarios and how you can or cannot accommodate and why.

This tool like the Contract Language Manual is a pivotal tool to building a high performing team.

 

Summary:

The common theme in these 5 power Tools for Managed Care Contracting is one of mindful preparation. In the words of Peter Drucker, we want to focus on getting the right things done, things that change the face of the organization.

Solid, well negotiated contracts have staying power and can yield value in terms of strategic and financial power to the organizations.

As good Scientific Cowboys, bite the bullet, invest the time and reap the rewards. Good luck!

 

About the Author:

Nancy C. Everitt, MBA, PMP is the President and CEO of HEOPS, Inc. and Editor in Chief of Scientific Cowboys. She is a recognized expert in managed care, expedited network development and a thought leader in transforming care delivery systems. Questions on this article may be addressed directly to neveritt@heops.com.

 

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It’s not about activity, it’s about results. However results alone are not enough, in Drucker’s words: to be effective you must complete the right things. — Nancy C. Everitt

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