Resource Details

Managed Care Data Checklist

Companion Document to Video Module: Payer Data: The Managed Care Data. Prepared by Starling Advisors for the HITEQ Center in July 2022.

Year Developed: 2023

Resource Type: Toolkit.

Primary Audience: Administrative Staff Clinicians PCAs
Secondary Audience: Board of Directors C-Suite (CEOs, CFOs, CIO, COOs, CMOs, etc.) Enabling Staff Outreach Staff

Language(s): English

Developed by: HITEQ (See other resources developed by this organization).

Resource Summary: How to Use This Checklist: This is a supplement to our Module 2: The Managed Care Data Set, which uses the HCP-LAN APM Framework as its basis. Review both before using this checklist. There are terms used throughout that may be new to you or may benefit from detailed explanations—please visit our Value Based Payment Glossary for basic definitions for a host of key terms.

Resource Details: How to Use This Checklist: This is a supplement to our Module 2: The Managed Care Data Set, which uses the HCP-LAN APM Framework as its basis. Review both before using this checklist. There are terms used throughout that may be new to you or may benefit from detailed explanations—please visit our Value Based Payment Glossary for basic definitions for a host of key terms. This checklist will walk you, the health center, through a series of common considerations for contracts you may receive from payers with a specific focus on contracts that include value-based payment components. This document assists organizations in understanding the necessary data and data-related tools for managing population health within a managed care environment. It is a primer on the types of best-practices that are necessary to maximize care delivery models that are responsive to value-based payment programs. Follow this checklist to further your understanding of these considerations and to help flag any outstanding issues for legal and/or consultant review prior to execution. It is important to understand, contracts can be complicated and no one tool can effectively address all possible contract configurations and their potential issues. Use this as a guide with other resources, access outside expertise when needed, and apply your own knowledge and understanding of your business. It also never hurts to ask the health plan representatives if something is not clearly understood.

Resource Topic: , Value-Based Health Care Transformation

Resource Subtopic: Population Health, Value-Based Payment, Social Determinants of Health (SDOH).

Keywords: Access to Care, Business Intelligence, Care Coordination, Clinical Coding, Contracting, Health Systems, Implementation Tools, Insurance and Claims, Medicaid, Non-Clinical Services, Partnerships, Patient Demographics, Patient Portals, Patient Satisfaction, Payment and Reform, Performance Improvement, Quality Measures, Risk Management.