Cast aside old managed care model
It’s time to move away from accepting managed care patients on a case-by-case basis, hospice experts say.
"Get a contract with a managed care company and begin establishing a relationship," says Lisa Spoden, MS, partner in Columbus OH-based consulting firm Strategic Health Care. Spoden is also the chairwoman of the Washington, DC-based National Hospice Organization’s managed care task force.
This relationship can only come if the two sides are bound by a contract that cements a partnership, explains Spoden. Without a contract, hospices that do business with managed care organizations (MCOs) are not afforded the same considerations given to their contractual partners.
"With a contract you’re an established partner with a managed care company," agrees Jenny Schrom, RN, CRNH, director of Hospice Alliance of the National Capital Area in Falls Church, VA. The Hospice Alliance is a group of 13 Washington, DC-area hospices joined together for the purpose of managed care contracting.
Entering into a contract gives hospices a chance to develop relationships with MCO case managers and claims personnel that can benefit when questions about claims or benefits arise.
"Having a well-established contact in provider relations to intercede for you is a huge asset," Schrom says.
The partnership between an MCO and hospice also can be used to promote hospice care, Spoden notes. The partnership allows hospices to educate the MCO on the benefits of hospice, while MCOs can use hospice workers to introduce the concept of palliative care to its patients. (For more information on how to work with MCOs, see story on p. 45.)
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