Establishing The Right Set Of Health Plan Contracts – The Right Plans, The Right Services, The Right Rates

The reach of health plans is increasing, and specialty provider organizations are paying attention. More complex populations are moving to managed care through health plans. Health plans are now covering more services. Over 75% of Americans with any type of insurance have their health benefits managed by some type of health plan, accountable care organization, or specialty benefit management company. That includes 85% of Medicaid enrollees, 95% of people with employer-sponsored plans, and 40% of Medicare beneficiaries.

Additionally, health plans’ expectations of their relationships with provider organizations have changed. For health plans, the "ideal" service delivery model has medical . . .