AHLA Health Plans Contracting Handbook: A Guide for Payers and Providers (AHLA Members)
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Real-life examples inform your negotiating and drafting.
The Handbook traces the managed care contracting process from preparing to negotiate the contract, to formation and implementation, to termination issues.
With contributions from more than twenty authors, the book includes nearly 300 sample clauses, many from the authors' own files. The clauses provide variations in language to illustrate potential advantages to the respective parties, as well as factors to consider when negotiating in today’s dynamic legal and business context. This practical work also includes checklists, a health plan contracting term glossary, and a fully annotated provider agreement template.
The latest trends and emerging issues.
The authors address emerging issues in managed care contracting, including:
- Managed care penetration into Medicare and Medicaid
- Value-based payments and the associated financial and operational considerations
- Large health systems launching as independent payers or through integrated delivery models
- The rise of direct-to-employer contracting
- A growing need to address uses and ownership of data
- Increasing focus on considerations when a provider does not have a contract with a payer
- And more!
A jumping off point for further research
Throughout the book, the authors provide cites to cases or state statutes for further research into the state of the law as needed.
Editor-in-Chief: Robin Fisk
Editors: Christina DeGraff-Murphy and Gregory Mitchell
Authors: Gerald "Jerry" L. Aben, Matthew Amodeo, Adam C. Aseron, Brooke Bennett Aziere, John C.J. Barnes, James W. Boswell, Aimee DeFilippo, Lisa G. Han, Andrew C. Helman, John M. Kirsner, David E. Kopans, Mark S. Kopson, Kathrin E. Kudner, Jacqueline B. Penrod, Christian Puff, Michael F. Schaff, Debra Silverman, Andrew Stein, Leah B. Stewart, Adam C. Varley, Amanda M. Wilwert
For full bios, click here.
The 7th Edition ISBN was 9781632806130.
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Published March, 2021.
Table of contents
Recent Titles from the American Health Law Association
About the Editors
About the Authors
About the American Health Law Association
1 Introduction: Basics of Contracting and Negotiating
2 Accountability and Collaboration in Payer-Provider Relationships
3 Antitrust Issues in Payer-Provider Contracting
4 Key Contract Definitions
5 Policy and Procedure Amendments
6 Payer Programs and Policies: Utilization Management and Quality Assurance
7 Payment Methodologies
8 Term and Termination Provisions
9 Insurance Requirements and Indemnification
10 Other Material Contract Provisions
11 Provisions Related to Data Sharing
12 Dispute Resolution
13 Protecting Against Insolvency
14 Medicare Managed Care Contracting
15 Medicaid Managed Care
16 Direct-to-Employer Contracting
Appendix A Glossary of Health Plan Contracting Terms
Appendix B Table of Sample Clauses
Appendix C Physician Group Practice Provider Agreement Template with Commentary