Inside the Mind of Managed Care Contracting Executives

by Clive Riddle, May 5, 2010

MCOL, in conjunction with the Health Plan Contracting Web Summit, just concluded an e-poll on contracting issues. Respondents were asked “What are the greatest opportunities from a contracting perspective?” and chose accordingly from the following answers:

Response	Percent
Advancements in analytics capabilities	7.5%
Advancements in electronic health records and transactions	16.7%
Consumer engagement initiatives	10.8%
Emergence of value based and newer payment models	26.7%
Formation of Accountable Care Organizations	16.7%
Increased covered population due to health reform	17.5%
Potential growth in patient centered medical homes	3.3%
Other	0.8%
Total	100.0%

Respondents were also asked “What are the greatest challenges from a contracting perspective” and chose as indicated from the following answers:

Response	Percent
Consumer engagement Initiatives	9.9%
Continued market consolidation	14.1%
Cost pressures due to economic downturn	28.1%
ICD-10 transition	6.6%
Increased complexities of benefit design	8.3%
Increased mix of government program vs. commercial covered populations	14.9%
Issues related to new health reform provisions	14.0%
Other	4.1%
Total	100.0%

121 professionals responded to this e-poll, and indicated the following perspectives:

Purchaser                               24.0%

Provider                                 55.4%

Vendor/Other                          20.6%

So, while respondents indicated there is clearly a mixture of factors, and not just one single opportunity or challenge that requires their focus, the emergence of value based and newer payment models, and cost pressures due to the economic downturn are certainly the front runners commanding their attention.