(Risk) Contract Services
H&A has been negotiating
risk contracts since they were first introduced in the 1980s. We have
had extensive experience in negotiating contracts with all the managed
care companies in the Northwest.
Since IPAs are legally structured
to negotiate risk contracts as one entity, negotiations should be
proactive and aggressive. Risk contract negotiations can be complex,
with numerous hidden clauses, settlement formulas, and payment issues
which can have a profound impact on financial results. We focus on
limiting downside risk, while increasing the opportunity for physician
groups or IPAs to realize significant financial gain.
We also work with
IPAs to develop internal risk-sharing and fund distribution options
among the IPA members.
PPO contracts are becoming more
important to physician practices, since HMO (risk) contracts are decreasing
in number and no longer exist in some service areas. H&A is familiar
with virtually all PPO contracts in the Northwest, whether they are
offered by local or national companies.
Unfortunately, it is illegal
for non-integrated physician groups or IPAs to negotiate any financial
component of PPO contacts. H&A offers two programs which can be
of great benefit to the members of non-integrated groups and IPAs.
PPO (Non-Risk) Contract Services - Direct PPO Consultant (back
H&A has developed a program
where H&A serves as the “direct PPO consultant” to
IPA member physicians.
H&A enters into a contractual
relationship with the IPA. The IPA is billed a set monthly fee. In
return, any IPA member can correspond (via telephone, fax, email)
directly with H&A to discuss any PPO contract issues, including
payment levels and expectations. H&A is allowed to give recommendations
regarding both payment and non-payment issues. The physicians then
deal directly with the insurance companies to finalize contract terms.
This service is
provided at a very reasonable cost to the IPA, based on the size of
If your IPA has
agreed to offer this service to the members of your IPA, you may access
us at this time or in the future by completing the PPO
Consulting Contact Form and submitting it to us. If you prefer,
you may call us or email us directly.
PPO (non-risk) Contract Services - Super Messenger Model (back
Some IPAs determine
that their members do not want to deal directly with insurance companies,
and decide to use the Super Messenger model.
H&A has provided super messenger
services for numerous groups over the past 10 years. This service
depends on a great deal of cooperation and commitment by all IPA members
but it can be effective for those physicians and groups who are not
interested in communicating with the insurance companies themselves.
Some IPAs have decided to use
the Super Messenger Model for selected PPO contracts and to utilize
the direct PPO consultant for all other contracts.
- Develop basic business plan, including
goals & objectives
- Develop legal documents with legal
- Coordinate membership recruitment
- Make presentations to interested
- Provide initial staff work, recruit
management if desired
- Coordinate/staff organizational
(back to top)
The following services
can often be provided more economically and efficiently than when an
IPA hires staff and develops its own infrastructure:
- Board meetings
- Preparation, attendance, follow
- Record, transcribe, and distribute
- Perform booking and banking functions
- Maintain all records, files
- Prepare annual renewal application
and financing for Professional Liability and D&O insurance
- Track, administer and distribute
- Correspond and communicate with
Board members and office staffs
- Correspond and communicate with
legal counsel, accountant, and all plans representatives
- Analyze, review and distribute
data and financial information from all HMOs
- Direct annual contracting negotiation
- Negotiate favorable HMO (risk)
- Contract administration
- Review, calculate and administer
- Consult with IPA leadership
- Develop budget and funding options
for IPA operations
- Perform other management duties
various physician business development services, including marketing
services, joint venture exploration and development, and new service
educational meetings for office staff which emphasize contract review
and contract negotiations.