AHLA Health Plans Contracting Handbook (AHLA Members)

ebook A Guide for Payers and Providers

By American Health Lawyers Association

cover image of AHLA Health Plans Contracting Handbook (AHLA Members)

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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 have thoroughly updated each chapter and added new chapters to 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!
  • AHLA Health Plans Contracting Handbook (AHLA Members)