Free Managed Care Contracts Essay Sample
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A contract is a legally binding document which involves an agreement between two or more parties. In case the contract has any elements of a valid legal agreement, it is therefore enforceable by law or binding arbitration. A contract with a legal agreement anticipates instances where the law might be breached and outlines the specific remedies for each breach. Some of these remedies cold include compensation to any aggrieved parties.
Some of the key elements in a contract include that of the existence of the contract. Another one is that of an offer being in place but at specified terms and conditions. This is given by the offerer and if accepted, it will be binding to whoever it is offered to. There also exists an element of absolute and unconditional acceptance t the offer either orally or written which reflects the offer that is made. There is also a section in some cases with a counter-offer which extinguishes from the offer. Lastly there is a request for information, which is ot a counter-offer but rather seeks for clarification about the terms therein.
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Well negotiated managed care contracts do offer long-lasting value to the providers, payors and patients. De Cruz (2001) asserts that, many providers have been accused of providing less than accurate language or word play to net quick returns also this usually puts the involved organizations in disrepute. This therefore means that contracting does not have to always involve gaming but rather careful consideration of legal issues that would affect the provider and the payor alike.
What matters to the provider most during contract negotiation is pricing because being a business, its main motivator should be a bid to make profits from its transactions with customers. Although this is always the case for most care managed organization, it should however not be reflected on how they deal with their clients. Matters such as the stability of the relationship with the customer should be of utmost importance as well as giving the right connections that would allow the existence of positive working relations with the client.
A contract should also show some level of predictability with respect to the prices and the payments by the payor during the period the contract is in place. The amount paid should be reasonable for the client over the long term and also be enough to make a profit for the organization. Therefore careful actuarial analysis can come in very handy in establishing these estimates for future and unforeseen scenarios.
Lastly, there should be provided an amicable solution in case any disputes do arise over the course of the contract that suits the provider and the payor. The consequences of any breach of contract or disputes are clearly spelt out and therefore known even before they can happen.
Contracts can sometimes be founded on illegal provisions that seek to undermine the payors rights and therefore defrauding them of their money's worth. According to Miller R. (2001,), if this is discovered however, they could lead to many consequences to the health care provider. Some of these loopholes include having patients to sign forms to promise that they would not rate the physicians who attend to them. This is sometimes referred to as patient gag and it can be used against the patients in case they under perform in their duties. These illegal aspects so contracts can lead to lawsuits which in return could give rise to the payors being compensated and have the contracts terminated.
The severability clause is a clause that would regulate the legal consequences as well as the validity and applicability of the rest of the contract in case part of contract ceases to be effective or feasible. It therefore expresses that in case of any deletion or change of an unenforceable clause would substantially result in material change and therefore make it unnecessary to continue with the contract. Therefore the implication of the unenforceable provision is that in case any of the other provisions in the contract or agreement are not unenforceable or considered to be unenforceable, the parties would therefore agree that all the other provisions would still have force and effect and in that way not affected at all.
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Therefore it is to say that the unenforceable law goes a way in ensuring that the entire contract remains viable even in cases when only a section of its provisions cease to be enforceable. In this way the entire contract does not become void and can still apply to the other clauses.
Therefore healthcare systems should always ensure that contract negotiations are carried out in a manner that would both be beneficial to them for the purposes of making profits. It should also be a key to note that they should overcharge the clients because this might make them less attracted to these health institutions. Another issue to take into account is giving the payor sufficient information before they enter the contracts. In this way mutual trust would be built and maintained between the two parties and will help in maintaining a long-lasting relationship.
The government is also cracking down on health providers that are involved in contracts that tend to undermine the civil rights of the clients and in this way making healthcare companies become more and more careful in the contracts they sign up with their clients.