CONTRACTING

Contracting

The market stability and future growth of an IPA is dependent upon its ability to obtain new HMO, PPO, EPO and other contracts. Constant review, utilization analysis, communication with Plans and knowledge of current trends in the industry are important renegotiation tools. AMM will provide support to the IPA with extensive industry knowledge and negotiating experience. AMM has a favored relationship with many Health Plans and has developed intimate and cooperative contacts within the Provider Relations and Contracting departments of most Health Plans.

In addition to Health Plan contracts, other ancillary contracts require negotiation and periodic re-negotiation. Prior to these negotiations, certain analysis and review is required. AMM provides such analysis and can negotiate contracts for family planning, vision care, mental health, medical equipment, radiology, laboratory, extended care, etc. When contracting with HMOs and other managed care organizations it is necessary that all services provided to the patient population either be provided within the IPA or contracted out to specialist physicians and ancillary providers at acceptable rates. In this regard, AMM can evaluate the services provided within the IPA -- by specialty and geographic area -- and indicate those areas where additional coverage is required. AMM works to identify additional providers with which to contract and negotiates acceptable rates. AMM can ensure that a comprehensive network of providers is under contract to provide all services reasonably required by the patient population.