Managed care contracting for specialists.

Abstract

Specialty managed care contracting requires specialists to understand their role in managing care, as well as carve-out and subcapitation agreements. Specialists should know their referral sources, their costs for providing care, and how to provide care that meets their referral sources' needs and the payers' requirements. Once specialists enter carve-out or subcapitation arrangements, they need to determine the best payment calculation method for their practice. Three methods to consider are resource-based relative value scale, per-referral basis, and a point system. Because each method produces different results, providers need to understand each method and the unique concerns of specialty managed care contracting to negotiate the best contracts for their situation.