Contract Management Curriculum

Welcome to the Contract Management Curriculum. This curriculum is designed to help you better understand your commercial contracts and how to be successful in contract negotiations.

There are 6 chapters for this curriculum, made up of both workbooks and webinars to help guide you through the program.

This content was developed and produced using funding from the Colorado State Innovation Model, a federally funded, Governor’s Office initiative. Learn more: www.co.gov/healthinnovation.

This beginning chapter will provide an introduction to forming relationships and working on contracts with your commercial payers.

We will cover the basics of what payer contracting is, an overview of the local Colorado insurance market, and touch on how and why your data is such an important piece in this process.

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Introduction to Payer Contracting and Relationships
Section 1 – Overview of Contracting Basics
Section 2 – Local Market Breakdown
Section 3 – Using Practice Data in Contracting

In this chapter we will review the three most common reimbursement models utilized by payers (Fee for Service, Per Member Per Month, and Value Based) and also analyze the risk that is associated with your contracts.

This chapter will cover the nuances of each reimbursement model along with the best ways to use your practice information to effectively analyze risk and negotiate your commercial contracts.

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Chapter 2 – Contract Reimbursement Models
Section 1 – Fee for Service Overview
Section 2 – Per Member Month Overview
Section 3 – Value Based / Shared Savings Overview
Section 4 – Analyzing Risk in Contracting
Section 5 – The Importance of Data

This chapter will cover some Managed Care Contracting Strategies, which will help you structure your thoughts and bring your information to the payers. It is imperative to put a plan together before you approach the Health Plans in order to have an effective conversation.

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Chapter 3 – Contracting Strategies for Success
Section 1 – Preparing Your Strategy
Section 2 – Know Your Data Sources
Section 3 – How to use Your Data and Why it is so important

This chapter will teach you how to build lasting relationships with your payers by presenting your information in a way that will help effectively negotiate your contracts. This includes impactful communication techniques and knowing who to contact with questions or concerns.

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Chapter 4 – Communicating with the Payers
Section 1 – Proper Channels of Communication
Section 2 – Building Relationships with your Commercial Payers
Section 3 – What do the Payers want to know?

This chapter will take everything we have discussed throughout the curriculum thus far,and apply it to adding behavioral health services to your commercial contracts, as it is appropriate. We will review the process as a whole and break it down into steps when it comes to working with your commercial payers.

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Chapter 5 – Connecting the Dots in your Commercial Contracts
Section 1 – Analyze your Payer Mix
Section 2 – Understand your Contracts
Section 3 – Strategize using Practice Information
Section 4 – Have the Conversation with your Payers

This worksheet is designed to help you follow along through the contract review and redline. You will find title headings for each section that is reviewed in the Chapter 6, Section 2 webinar. Use this worksheet to follow along and take any notes you have from the video. We recommend that you print off a copy of the sample contract and read along with the Webinar. As a reminder, it is always acceptable to print a copy of your contract and write in any changes you may have.

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Chapter 6 – Redlining a Sample Contract
Section 1 – Analyzing the Structure of Commercial Contracts
Section 2 – Redlining the Contract
Section 3 – Completing the Contract