Managed Care Contract Negotiations
Jul 30

Tips for creating a payer report card

Amid the flurry of pay-for-performance activity, a growing number of providers hope to develop tools to measure and monitor contract performance at the functional and operational levels of the organization. That’s where the payer report card comes in.

The payer report card is really a contract management system. Collecting all of the data and being able to stand back and look at the big picture gives providers more information and thus more leverage in negotiating their contracts with health plans.

Use the following tips to create your payer report card:

Developing a data warehouse is critical to creating your own payer report card. This involves taking data from several different systems and bringing them into a common platform—a data warehouse.

Compiling the data involves speaking with individual departments and holding joint meetings with department managers. This should then be followed up with a presentation about proposed data elements.

Once you’ve gathered the information, it can be sorted into two levels of report cards: functional and operational. Functional report cards are detailed and fairly complex. They are only necessary for high-volume payers (e.g., commercial and Medicaid). Operational report cards, which are more quantitative and objective than functional report cards, can be generated for potentially all contracted plans. Most of the information needed to produce these report cards can be pulled straight from the data warehouse.

About Reed Tinsley, CPA

As a top advisor to physicians, I help increase practice profits by delivering hands-on, expert medical accounting/tax support, practice counsel, and revenue-building strategies. Read more →