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Why focus on Managed Care?   Despite the rapidly changing health care environment under managed care and the need for alterations in relationships among patients, physicians, and hospital organizations, there is little educational information on how different aspects of managed care influence provider reimbursement and revenue integrity. Healthcare professionals need education to understand the benefits, challenges, and responsibilities of working in a managed care environment if they are to adopt new approaches to maintaining and improving quality of care for their patients; and, they need standards to guide them effectively under the new and evolving managed care rules within the revenue cycle.

Your Payer Mix has Changed! Since 2010, the payer mix of most hospitals has seen an increase in the percentage of payment from Managed Care, increasing from roughly 15% to 35% or more! Payer mix shifts occurred as the Medicare FFS category decreased with a shift to Medicare Advantage, the Medicaid FFS category has decreased with a shift to Medicaid CMOs, and a portion of State Health Benefit Plan dollars have shifted to Medicare Advantage for retirees. All of these shifts result in increased Commercial Managed Care. This has made the Managed Care/Commercial Payer category the largest for many hospitals, yet very little time has been spent focusing on this adjustment and what it means for hospital business practices.

The 2016-17 HomeTown Health Managed Care Standards & Training Consortium was created to address these needs. Program education will be delivered through:

  • Education and standards developed to guide hospitals through the new and evolving managed care environment, learning about managed care contract compliance and its effect on the revenue cycle and your financial success.
  • Monthly educational Managed Care Webinars
  • 6 Online Managed Care Courses:risah 2017
    • The History of Managed Care in the United States
    • Managed Care Contract Compliance Oversight and Terminology
    • Understanding Medicaid Managed Care
    • The Management of Managed Care
    • Defining and Accounting for Contractual Allowances
    • Utilizing Managed Care Claims Data Effectively for Improved Revenue
  • 2-day Managed Care/ Revenue Integrity/ Reimbursement Boot Camp
  • Continued ICD-10 support and access to ICD-10 education and quarterly webinars, to help reduce the negative impact on productivity and reimbursement post ICD-10 transition.
  • Assistance with communications and collaboration between payers and providers, helping them work together in this new environment.

Click here to access program information and
the Registration Form.
Click here to listen to the June 9th Program Kickoff Webinar, or download the handouts:
 HTH Kickoff Webinar Handouts /
Why Care About Managed Care? Handouts

For more information about this program, please contact:

Kristy Thomson, COO