• Hypertrophic Cardiomyopathy (HCM)
  • Vaccines: 2023 Year in Review
  • Eyecare
  • Urothelial Carcinoma
  • Women's Health
  • Hemophilia
  • Heart Failure
  • Vaccines
  • Neonatal Care
  • Type II Inflammation
  • Substance Use Disorder
  • Gene Therapy
  • Lung Cancer
  • Spinal Muscular Atrophy
  • HIV
  • Post-Acute Care
  • Liver Disease
  • Biologics
  • Asthma
  • Atrial Fibrillation
  • RSV
  • COVID-19
  • Cardiovascular Diseases
  • Prescription Digital Therapeutics
  • Reproductive Health
  • The Improving Patient Access Podcast
  • Blood Cancer
  • Ulcerative Colitis
  • Respiratory Conditions
  • Multiple Sclerosis
  • Digital Health
  • Population Health
  • Sleep Disorders
  • Biosimilars
  • Plaque Psoriasis
  • Leukemia and Lymphoma
  • Oncology
  • Pediatrics
  • Urology
  • Obstetrics-Gynecology & Women's Health
  • Opioids
  • Solid Tumors
  • Autoimmune Diseases
  • Dermatology
  • Diabetes
  • Mental Health

More on contracting from December Special Report


Read more about provider contracting

Hi-Tech Contracting

Technology is an important factor in effecting successful contractual relationships between insurers and providers, but mostly from an administrative viewpoint. The Trizetto Group, a healthcare information technology company headquartered in Newport Beach, Calif., makes contracting easier with its NetworX Modeler and NetworX Pricer. Based on a plan's historical claims data, the Modeler presents potential financial impacts of varying contractual terms, and helps make comparisons between the cost of procedures by different providers.

Jeff Hensley, chief technology officer for Trizetto, believes, however, that episodic discounting rather than contracting based on procedures will lead to incentivizing providers to do the best job possible, rather than providing incentives to overutilize and overprescribe.

He considers the NetworX Modeler to be a good negotiating tool and if reimbursement methodologies change, he says can still see the financial impact and knows exactly to what he is agreeing.

The more predictability with price, the better, McIntire says, enabling WellPoint to promote its strategy of long-term contracts. "These contracts assure providers that they will remain in the network and assure members that their providers will be available, while avoiding the risk that a competitor will negotiate a better rate."

Related Videos
Video 11 - "Closing Current Gaps within Fertility Benefits and Care"
Video 10 - "Shaping Fertility Coverage: Access, Costs & Medical Needs"
Video 9 - "Denial of Coverage in Fertility Care"
Video 8 - "Risks of Miscarriage and Multiple Births Associated with Fertility Care"
Video 7 - "Fertility Preservation: Egg Freezing Versus Embryo Freezing"
Video 6 - "Family Building Costs, Barriers, and Dropout Rates Associated with Fertility Care"
Video 5 - "Closing Payer Gaps and Improving Fertility Care Access"
Video 4 - "Increasing Employer Coverage and Maximizing Fertility Benefits "
Video 5 - "Relevance of NUTURE Study Findings for Patients, Payers, Providers"
Video 3 - "Improving IVF Success Rates & Utilizing AI in Fertility Health Care"
Related Content
© 2024 MJH Life Sciences

All rights reserved.