New Managed Care Contract

Analyze a New Managed Care Contract
Instructions
In this scenario, you are a financial analyst for your healthcare organization, reporting directly to the Chief Financial
Officer (CFO). Part of your role is to identify and negotiate optimal financial coverage sources while maintaining quality
services for patients. Based on the information provided below, provide an analysis of the pros and cons of entering into a
contract with a national managed care organization new to your service area.
Alright Citizens Services (ACS) health insurance company, a national organization that insures approximately 10% of all
Americans, is starting to provide coverage to individuals in your service area. ACS is very aggressive and has been
successful in every market it enters. ACS will provide commercial, Medicare, and Medicaid products to individuals and
companies in your service area. ACS has offered you a five-year contract with the following terms:
Commercial and Managed Care Payors:
• Year 1 payments: 5% below your best payor, equal to your average payment rates.
• An increase in Year 2 of 3% based on the Consumer Price Index (CPI)
• No increase in payment rate in Years 3-5.
• By Year 3, ACS payment rates will be below your average payment rates; and by Year 5, it will be 10% below.
• Capitation payment for outpatient Radiology and Therapy services equal to the average capitated payment from
other payors.
Medicare:
• Year 1 Medicare rates + 2%
• Year 2 Medicare rates + 1%
• Year 3 Medicare rates
• Year 4 Medicare rates less 2%
• Year 5 Medicare rates less 5%
Medicaid:
• All years’ rates equal to rates published by the state’s Office of Medical Assistance
If history holds, ACS will gain market share at 2% per year, equaling 10% by Year 5. You are in a very competitive market
with five competing hospitals in your primary and secondary service areas.
Using this information, provide an analysis of the pros and cons of your healthcare organization entering into a contract
with ACS. Submit a recommendation document and analysis to the Board of Directors that discusses the pros and cons of
the financial strategy related to the cost of healthcare outcomes drawn from the resources.
Length: 3-5 pages
References: Include a minimum of 5 scholarly resources.
The completed assignment should address all of the assignment requirements, exhibit evidence of concept knowledge,
and demonstrate thoughtful consideration of the content presented in the course. The writing should integrate scholarly
resources, reflect academic expectations and current APA standards