Managed Care Organization (MCO) Team Project “Contracts Review”

You are the new CFO, of UMUC Medical Center, a 120 multi-skilled level three (3) healthcare facility. You have summoned a team of healthcare and business experts to assist with the process of contract negotiating. Based on the federal mandate of the Affordable Care Act (ACA), prepare a proposal summarizing the team’s final recommendations in preparation for an upcoming meeting. 

Devise a proposal that addresses the following:

Present a four to five (4-5) page proposal recommending the team’s final decision based on the review of National Committee on Quality Assurance (NCQA), 2016-2017 health insurance plans rating that can be located directly at http://healthinsuranceratings.ncqa.org/2016/Default.aspx. The proposal must identify the following:

Conduct a one (1) page analysis of the ACA and its future implications on managed care organizations (in particularly in reference to reimbursement)
Create a one (1) page checklist that will be utilized as a tool to review managed care contracts presented to the organization.
A one year (1) financial analysis as a predictive measure/tool projecting the financial performance based on the adoption of the selected health plan and reimbursement model [based on fictitious data and figures]
Identify at minimum three (3) involved parties the team recommends as a contributing player in the review of all managed care contracts under consideration. Briefly, support your reasoning for each recommended person to participate in the review.

 Submit one (1) single Microsoft Word document  

Resources:
Successfully Negotiating Managed Care Contracts: http://www.hfma.org/Content.aspx?id=16658

Managed Care Answer Guide: http://www.patientadvocate.org/requests/publications/Managed-Care.pdf

Managed Care Contracts – Key Provisions for Providers  https://corporate.findlaw.com/law-library/managed-care-contracts-key-provisions-for-providers.html

National Council on Disability (2013).  Chapter 1. An Overview of Medicaid Managed Care.  https://www.ncd.gov/publications/2013/20130315/20130315_Ch1/

Tinsley, R. (1998, September/October).  Negotiating or renegotiating managed care contracts.. Medical Group Management Journal. pp. 66-71.  (In Week 4 Learning Resources)

Managed Care Contracting Toolkit: https://www.glms.org/Content/User/Documents/PPAC/ManagedCareToolkitComplete.doc

Sample Managed Care Contract Template: https://www.aaaai.org/Aaaai/media/MediaLibrary/PDF%20Documents/Practice%20Management/Office%20Operations/sample_managed_care_contract.pdf