Healthcare contract management relying on outdated, manual processes can significantly hinder efficiency for stakeholders involved in managed care contracts. These inefficiencies can lead to decreased revenue and increased liability. Bottlenecks within the contract lifecycle management process can diminish resource efficiency, jeopardize contract security, and create disorganization of vital data. Discover how leveraging six key Managed Care Contracting Tools can lead to stronger, more effective contracts.
What is a Healthcare Contract in Managed Care?
In the context of managed care, a healthcare contract represents a legally binding agreement between participating entities. These entities typically include managed care organizations (MCOs), healthcare providers, hospitals, and ancillary service providers. A managed care contract meticulously outlines the responsibilities, roles, and financial agreements between each party, ensuring compliance with relevant state and federal regulations specific to managed care. A poorly constructed managed care contract, lacking essential components, can place all involved parties at risk.
What is Healthcare Contract Management in Managed Care?
Effective healthcare contract management within managed care streamlines processes across the entire contract lifecycle. This includes contract initiation, negotiation, execution, and renewal, ideally within a centralized, digital system. When managed care contract management relies on fragmented, disconnected processes, it can:
- Diminish the efficiency of managed care contract operations.
- Elevate unnecessary risks associated with managed care agreements.
- Expose the managed care organization to potential vulnerabilities and compliance issues.
Managed Care Contracting Tools: Software Solutions
Managed care contracting tools, particularly specialized software solutions, centralize processes, technology, and personnel within a unified platform, empowering managed care contract managers. Without dedicated managed care contract management software, healthcare professionals can be overwhelmed by the complexities of manually coordinating various contract lifecycle management stages. These manual efforts often involve disparate systems like shared drives, physical filing cabinets, and email exchanges, leading to inefficiencies and potential errors.
Streamline managed care contract workflows with dedicated software designed for healthcare organizations.
Tool #1 – Comprehensive Contract Lifecycle Management for Managed Care
Without a comprehensive approach to contract lifecycle management, professionals handling managed care contracts can easily find themselves in a state of disarray. Fortunately, advanced source-to-contract lifecycle management (CLM) software offers a centralized solution for managing all aspects of the CLM process, from initial requests to contract renewals. This encompasses crucial functionalities such as:
- eSourcing specifically for healthcare vendors and providers.
- Robust vendor management within managed care networks.
- Automated contract requests tailored to managed care agreement types.
- Intelligent contract authoring with pre-approved clauses for managed care.
- Streamlined online contract negotiations with providers and payers.
- Electronic approvals to expedite internal processes.
- Secure eSignatures for legally binding agreements.
- Powerful post-execution contract tracking tools to monitor performance and compliance.
Tool #2 – A Secure Contract Repository for Managed Care Agreements
Healthcare organizations that depend on shared drives, physical filing cabinets, and other insecure contract repositories expose their sensitive managed care agreements to significant vulnerabilities. Leading-edge health contract management software providers, compliant with security standards like SOC 1 and SOC 2, and adhering to Privacy Shield principles, offer secure and digital centralized storage for managed care contracts. This significantly reduces risks and builds trust with all counterparties, including providers and payers. Users can effortlessly search for documents, metadata, contract terms, and specific keywords within a secure, easily accessible database.
Tool #3 – Intelligent Workflow Automation in Managed Care Contracts
Managing each phase of managed care contract administration can become overwhelming without effective automation capabilities. AI-powered healthcare contract management software, equipped with intelligent contract workflow automation, mitigates bottlenecks by automating key processes such as:
- Seamless contract collaboration among internal teams and external providers.
- Streamlined negotiation workflows with version control and audit trails.
- Automated approval routing based on contract value and type.
- Comprehensive audit trails for compliance and accountability.
- Milestone tracking for key dates and deliverables within managed care agreements.
- Proactive compliance management with automated alerts for regulatory changes.
- Management of critical contract dates, including renewals and expirations.
- Automation of other routine contract-related tasks.
This automation empowers managed care contract managers to dedicate more time to strategic contract performance management and provider relationship optimization.
Discover essential features for choosing the right Contract Lifecycle Management (CLM) software for your managed care organization.
Tool #4 – Searching & Tracking Oversight for Managed Care Contract Performance
Searching and tracking oversight within managed care contract management can be exceptionally challenging and time-consuming without utilizing a robust CLM tool. Reputable contract management software provides managed care contract managers with powerful reporting, contract analytics, and financial tracking functionalities. Contract managers can thoroughly assess detailed audit trails, track contract spending against allocated budgets, monitor employee task performance, analyze vendor/provider line items, and gain valuable insights into contract performance metrics crucial for managed care networks.
Tool #5 – Contract Management Reports for Managed Care Organizations
Generating contract management reports by manually compiling data from various sources can be an incredibly tedious process for managed care organizations. Leading-edge healthcare CLM software enables managed care contract managers to generate robust ad hoc reports on virtually any data point. This includes financial commitments, contract performance against managed care objectives, and critical dates. These reports can be visualized in executive graphical dashboards and exported in various file formats for easy sharing and analysis across the organization.
Tool #6 – Compliance Oversight in Managed Care Contracting
Maintaining compliance is a significant challenge for managed care contract managers when manually evaluating contract adherence against evolving regulatory standards. Future-oriented contract auditing tools within healthcare CLM software empower managed care contract managers to efficiently track diverse compliance standards – including HIPAA, OFAC, and specific federal and state regulations impacting managed care – to proactively manage risk variables. This capability is particularly advantageous when evaluating vendors and providers against OFAC’s national sanctions lists and ensuring adherence to managed care specific compliance requirements.
Enhance risk management and compliance in managed care contracting with OFAC search capabilities within CobbleStone Software.
Stronger Managed Care Contract Management with CobbleStone Contract Insight®
Fortify your managed care contract management processes with a comprehensive, seamlessly integrated healthcare contract management solution. Holistic managed care contract lifecycle management starts and concludes with CobbleStone Contract Insight.
It’s understandable why Quadrant Knowledge Solutions recognizes CobbleStone as a CLM Leader in the Spark MatrixTM Report!
CobbleStone’s trusted, award-winning, and fully integrated contract management software for healthcare, including managed care organizations, delivers both robust governance and operational flexibility. CobbleStone’s user-friendly, powerful, and scalable solution seamlessly integrates with essential applications for effectively managing managed care contracts and related agreements.
Discover why thousands of contract managers – including those within the managed care industry – rely on CobbleStone Software for their contract management needs. Request a free demo today!
Request a complimentary demo of CobbleStone Contract Insight to explore its managed care contract management capabilities.
This blog was originally published on September 1st, 2021, and was updated on April 12th, 2023.
