How MLR Can Hurt or Help Contract Negotiations

Karen Minich-Pourshadi, for HealthLeaders Media , January 10, 2011

Currently 1.5 million people use their system and it enables them to process at a minimum 50,000 clinical transactions a day. But one of the key features of the system is the point-of-care prompts.  

Point of care is another area where payers may be looking to providers to work with them, says Van Wagner. The process is actually quite simple. When patient X arrives for any routine appointment, if there is another routine preventive care procedure needed, then the payer’s system can prompt the provider to schedule it.

“Before medical loss ratio, payers had looked into this but they weren’t all that interested. As soon as medical loss ratio regulation came out, however, they [payers] started to perk up and ask questions. Now there’s a reason to participate and that’s a good thing,” says Van Wagner. “I view this as a nifty opportunity; we think the use of a point-of-care model is where there is the greatest return for the patient, and it’s transforming how we do things.“

Indeed point-of-care models do have the potential to be a very good thing for payers, providers and patients. It is certainly an idea that’s long overdue (especially when you consider that the automobile industry has been manufacturing cars for nearly a decade that remind drivers to get routine maintenance). The takeaway in all of this for hospital and health system financial leaders is to remember that the MLR regulation has the potential to make your payer negotiations sour or sweet. It really depends on how willing you are to work with your payers to help them control their costs without cutting your reimbursements.

See next week's finance column for tips on MLR.

Karen Minich-Pourshadi is a Senior Editor with HealthLeaders Media.
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