Managed Care - February 2009 - (Page 36) Today’s Technology Can Facilitate Collaborative Network Management Creating truly transparent management systems is in the interest of payers and providers, and is achievable By Emad Rizk, MD quality, the starting point must be a strategic initiative within the managed care or other type of payer organization. Collaboration — in spirit and in operation — begins internally, first with the creation of a network management improvement team. or two decades, network management has existed in an increasingly challenging environment. Efforts by health plans to control costs have been met by providers’ attempts to optimize payments. The resulting push and pull has left each group wary of the other. By Downstream services now, it is clear that this contentious cycle will yield This is likely to include the vice president for no winners. network management, chief operating officer, medRather, success is more likely to come to those ical director, and representatives of provider relawho take a collaborative approach to tions and finance. network management. New tools for Importantly, claims processing and collaboration will help reduce costs other downstream services must be for both payers and providers, and represented so that their needs are will help to bring about the transunderstood: Any changes in work parency that both sides desire. process will need to have their buy-in As always, plans and their manfrom the start. agers must understand their market, Together, this group will decide on its particular needs, and where the priorities and how to make them opproblems lie. Then, a manager must erational. prioritize, because no organization or Second, this group must also reach individual can change everything consensus regarding compliance and overnight. While reducing adminisrisk — both financial and operatration and billing costs remains a tional. The watchwords during this goal, today’s environment requires “The highest priority in a netsecond step should be: strategic, colwork management strategy,” says network managers to look further. laborative, and automated. After the Emad Rizk, MD, of McKesson strategy is defined, the third step is to Health Solutions, “should be concommunicate it throughout the orData exchange tracts that make payment timely, ganization. The challenge is not only for plans transparent, and seamless.” Important regional collaboration to work hand in hand with their prohas begun in recent years — among payers, among viders to produce high-quality and cost-effective providers, and between the two groups — and has care, but also to work toward the data exchange bebeen essential in moving forward on cost and qualtween payers and providers that is a key to the fuity measures. But it is the health plans themselves ture. that are in the best position to bring about the Once it is acknowledged that collaboration betransparency that is necessary to make collaboratween stakeholders is a key to improving cost and tion work. Solutions to well-defined problems will help us move forward. Emad Rizk, MD, is the president of McKesson Tiering and pay-for-performance measures have Health Solutions. He can be reached at increased the tension between payers and providers. Emad.Rizk@McKesson.com F 36 MANAGED CARE / FEBRUARY 2009
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