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Managed Care Contracting and Value-Based Models with Joe Russell

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Manage episode 446447818 series 3401731
Content provided by CHAP - Community Health Accreditation Partner. All podcast content including episodes, graphics, and podcast descriptions are uploaded and provided directly by CHAP - Community Health Accreditation Partner or their podcast platform partner. If you believe someone is using your copyrighted work without your permission, you can follow the process outlined here https://ppacc.player.fm/legal.

Joe Russell, Vice President of Network Management and Contracting at Strategic Healthcare shares his invaluable perspective on how community-based providers can thrive despite the dominance of managed care plans and the ever-present issues of fraud, waste, and abuse.
Our conversation uncovers the influence of pivotal regulatory shifts, such as the Affordable Care Act and CMS initiatives, on managed care. We navigate the delicate balance between cost containment and quality care, addressing critical challenges like authorization limits and the impact of timely payments on providers.
As we look to the horizon, our dialogue transitions into the evolving dynamics of provider-payer relationships, where data-driven quality metrics take center stage. The burgeoning landscape of managed Medicare Advantage plans demands a new level of collaboration between payers and providers, with an emphasis on trust and innovative cost-containment solutions.
We explore the significance of aligning with metrics like star ratings and rehospitalization rates to enhance opportunities and reimbursement. Value-based care in post-acute settings is poised for growth, and providers must lead the charge by understanding their costs and crafting compelling value propositions for managed care plans.
Join us as we chart the course for the future of healthcare, where collaboration and strategic partnerships will redefine success.

Visit our website
Connect with us - LinkedIn, Twitter, YouTube, Facebook
Make Lives Better

  continue reading

Chapters

1. Managed Care Contracting and Provider Challenges (00:00:00)

2. Future Trends in Provider- Payer Relationships (00:14:54)

43 episodes

Artwork
iconShare
 
Manage episode 446447818 series 3401731
Content provided by CHAP - Community Health Accreditation Partner. All podcast content including episodes, graphics, and podcast descriptions are uploaded and provided directly by CHAP - Community Health Accreditation Partner or their podcast platform partner. If you believe someone is using your copyrighted work without your permission, you can follow the process outlined here https://ppacc.player.fm/legal.

Joe Russell, Vice President of Network Management and Contracting at Strategic Healthcare shares his invaluable perspective on how community-based providers can thrive despite the dominance of managed care plans and the ever-present issues of fraud, waste, and abuse.
Our conversation uncovers the influence of pivotal regulatory shifts, such as the Affordable Care Act and CMS initiatives, on managed care. We navigate the delicate balance between cost containment and quality care, addressing critical challenges like authorization limits and the impact of timely payments on providers.
As we look to the horizon, our dialogue transitions into the evolving dynamics of provider-payer relationships, where data-driven quality metrics take center stage. The burgeoning landscape of managed Medicare Advantage plans demands a new level of collaboration between payers and providers, with an emphasis on trust and innovative cost-containment solutions.
We explore the significance of aligning with metrics like star ratings and rehospitalization rates to enhance opportunities and reimbursement. Value-based care in post-acute settings is poised for growth, and providers must lead the charge by understanding their costs and crafting compelling value propositions for managed care plans.
Join us as we chart the course for the future of healthcare, where collaboration and strategic partnerships will redefine success.

Visit our website
Connect with us - LinkedIn, Twitter, YouTube, Facebook
Make Lives Better

  continue reading

Chapters

1. Managed Care Contracting and Provider Challenges (00:00:00)

2. Future Trends in Provider- Payer Relationships (00:14:54)

43 episodes

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