Services

Some of the services we offer are defined below:

 
   

HMO (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 (Non-Risk) Contracts (back to top)

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 to top)

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 the IPA.
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 to top)

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.


IPA Development (back to top)

  • Develop basic business plan, including goals & objectives
  • Develop legal documents with legal team
  • Coordinate membership recruitment
  • Make presentations to interested members
  • Provide initial staff work, recruit management if desired
  • Coordinate/staff organizational meetings


IPA Management (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 up
    • Record, transcribe, and distribute minutes
  • 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 administrative fees
  • 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 process
  • Negotiate favorable HMO (risk) contracts
  • Contract administration
  • Review, calculate and administer settlements
  • Consult with IPA leadership
  • Develop budget and funding options for IPA operations
  • Perform other management duties as requested


Physician Business Development (back to top)

H&A provides various physician business development services, including marketing services, joint venture exploration and development, and new service development.

Physician Staff Education (back to top)

H&A provides educational meetings for office staff which emphasize contract review and contract negotiations.