Introduction
Contracts comprise an integral part of the health care system of the United States of America. Naturally, the managed care contracts are viewed as the core of this system as they regulate the relations between the medical facilities and patients at the legal level. As defined by the Dictionary of Business Terms (2009), managed care is the system of control over the situation when there are providers of health care services for people in need of the latter. Further on, Jecker (2008) refers to managed care as to a “variety of techniques for influencing the clinical behavior of health care providers and/or patients, often by integrating the payment and delivery of health care”, thus stressing ones again that managed care presupposes mutual responsibility of parties concerned.
Managed Care Contract Contents and Completion Process
A managed care contract should include all the basic provisions. Among the latter, there should be the indication of the mutual duties and obligations of the parties to the contract, as well as their rights according to the agreement.
The definitions section is especially important as it explains all the potentially vague terms as used in this particular contract (DeBlasio, 2004). Also, the managed care contract should contain sections dealing with payment terms, the medical necessity of the contract, and the mechanism of the contract termination (ACR, 2009). The process of the contract completion should include the stages of service provider choice, initial consideration of the services offered, a compilation of the mutually acceptable contract, careful studying of all contract points, and stipulation of the contract termination mechanisms (DeBlasio, 2004).
Managed Care Implications for an Agency
Legal and Ethical Implications
The introduction of managed care contracts in an agency involves proper attention paid to such legal and ethical implications as the ability of the agency not to be seduced by the potential benefits of the managed care for the health care providers and the need for this agency to focus on the patients’ needs instead of counting profit and giving bonuses to medical workers that manage to work at the highest cost-efficiency rates (Jecker, 2008). Also important is the ethical concern regarding the relations between patients and their practitioners as these relations, if built on money and not on health care needs of patients, might lose their core, i. e. trust of patients and readiness to cooperate for achieving the joint goal of providing the high-quality health care services (Jecker, 2008).
Potential Access Limitation
One of the main goals of managed care contracts, as Jecker (2008) argues, is to control and provide the proper access of the patients to the practitioners and health care services they need. However, Jecker (2008) also argues that managed care contracts are often far from achieving their goals, as one of the negative implications of managed care for an agency is that the managed care contracts might facilitate the limitation of the access of patients to the practitioners and the lack of freedom of choice concerning the practitioner and the overall health care services provider (Jecker, 2008). Thus, managed care contracts, although initially designed to facilitate the health care system development, might become a threat to free choice and health care services quality in the US agencies.
Additional Services Required
It is also worth noting that managed care contracts do not typically require additional services to be provided by agencies. Even on the contrary, DeBlasio (2004) argues that the contract in which an agency promises to provide the services it does not usually provide is not a properly structured document and it might become a subject of controversy during the effective period of the contract. Here, special importance is attributed to the Covered Services point and the Definitions section of the managed care contract as the document should define clearly what services are covered and if there is any chance for obtaining services not included in the list (DeBlasio, 2004). There is a possibility that an agency might want to attract more clients to its managed care system and include additional services to the Covered Services point, but in this case, the additional services should be of high quality.
Managed Care Contract Termination
Termination Cases and Process
Finally, managed care contracts should contain the point regulating the terms of termination of the contract (Jecker, 2008). The cases when the managed care contract can be terminated vary from one document to another and depend upon the patients’ duties and rights and the terms of operation of the health care provider. However, the generalized causes for managed care contract termination include:
- violation of contract terms by one of the parties to the contract;
- change of the patients’ or health care provider’s terms or opportunities (including financial eligibility and employment);
- any other reasons of the patient or health care provider (as managed care contracts often contain an option of the contract termination without reporting the cause) (DeBlasio, 2004; Jecker, 2008).
The procedure of the managed care contract termination should include the consideration of termination conditions by both parties, meeting of the parties to discuss and/or report the contract termination, and support the fact of termination by either respective documents or, if stipulated in the contract, without such a document.
References
ACR. (2009). Evaluating a Managed Care Contract: ACR Managed Care Committee Contract Evaluation Checklist. Web.
DeBlasio, S. (2004). Managed Care Contracts – Key Provisions for Providers. From Find Law. Web.
Dictionary of Business Terms. (2009). Managed Care Definition. Web.
Jecker, N. (2008). Managed Care. Web.