What is MMHS?

MMHS provides your physician practice with an effective, national level, managed care negotiation consulting service that works with you, to clearly define your managed care contracting objectives and deliver tangible results, not reasonably achievable with traditional approaches. 

MMHS’s Basic Business Tenets

• Produce results well beyond alternative options
• Clearly communicate reasonable, achievable goals
• Prior approval on all consulting fees and expenses
• Empower your practice to evaluate specific progress weekly; if your practice is not satisfied, you don’t pay consulting fees. Period.
• No hidden fees or add-on expenses.

The idea behind this approach is proficient resolution to managed care issues without distractions, by providing your physician practice access to key negotiating skills precisely when you need them.

An Uncommon Path to Conflict Resolution

MMHS resulted from years of working with physician practices, hospitals, and health plans in managed care negotiations, and managing HMO/PPO networks.  Having actively negotiated with, or on behalf of, health plans in seventeen states, my observation is that essentially all practice executives, many office managers, and a substantial number of physician/practice executives have experience negotiating managed care contracts.  This approach can work, sometimes well, but more often, the combination of split attention and, most importantly, “emotional bias” substantially degrades the business results.

Managed care oversight from off site leased-management or freelance consultants, rarely achieves strong results, nor provides the best solution over time.  Long term, long distance, corporate or independent consulting has an unmistakable tendency to generate too many reporting requests for your staff, and often frames negotiation positions with managed care payers insufficiently matched to your specific physician practice needs.  This lessens your ability to identify and seize unique market opportunities, and tends to alienate the local management team, as well as, physicians within your practice.

I chose to develop Mutual Managed Health Solutions because I saw a better way.  My method of negotiation achieves maximum results for physician practices because my method obviates the vulnerabilities of most contract negotiations: emotional bias, split attention, and mixed objectives. 

My method emphasizes:
1)  active listening to all sides of an issue, while demonstrating genuine mutual respect
2)  relentless focus on all the contract issues that best serve your practice’s interest
3)  unshakable emotional neutrality
4)  deep knowledge of all aspects of managed health care negotiations and contracts.

MMHS succeeds in resolving managed care, payer performance, and contracting issues when others fail because I, and other consultants contracted through MMHS maintain a rapport with payers, while methodically wearing down the obstacles that otherwise seriously degrade your business results. This negotiation style, although extremely effective, requires strategic patience, which comes from an experienced negotiator that absolutely enjoys the negotiation process.

MMHS offers key short-term assistance and a broad spectrum of service.

While serving locally and regionally at Director and VP levels of network management for HMO and PPO networks, I learned that most physician practices have little chance of achieving mutual results with payers without key short-term assistance.

But effective consultation/negotiation is short term.  As an independent consultant structured through MMHS, I can use a broad spectrum of resources to serve your practice, including bringing in other consultants with specific success histories in particular specialties, business situations, and markets, as part of a platform of services to achieve pinnacle results for your practice.

The Status Quo means your physician practice pays.

Too-rapid negotiations generally favor the payer because payers craft contracts and operational policies; therefore, “status quo.” means the physician practice invariably pays the price.

From experience, which includes many conversations with physicians and fellow plan executives, it is clear that although most negotiations at least begin cordially, there is deep skepticism between physicians and health plan executives regarding what constitutes “reasonable” interests.  In addition, each side tends to believe their distrust is invisible on the other side of the table.  Taken together, these attitudes kill the opportunity for in-depth discussions that lead to changes over time.  I pace the negotiations to include the necessary in-depth discussion, which optimum results require.

How my approach changes your managed care negotiation results.

Draw In Senior Management

No doubt, your practice feels the daily frustrations that result from a health plan where your physicians, practice executives, and back office staff wait on hold to access very polite policy robots.  It is next to impossible for a smaller practice to sit across the table from an actively listening person, and even less likely that the person has decision-making capacity.

 

Knowing the plan level “CEO” is great for relationship building and can impact contracting, but, excepting smaller networks, most contracting decisions are among corporate headquarters, the network VP and COO for that region; therefore, that’s where negotiating effort needs to be focused.  Particularly in complex “value added” service situations and operational performance issues, plan “care and information management”, cooperation and support is a critical component of sustainable results.  Drawing senior management in, as opposed to demanding their participation, generates an enormous advantage that most practices miss. 

Knowing the talking points and authority of each management level, I work with the Provider Representatives, Contract Managers, and Directors to precisely frame the action-points with which the VP or COO can make decisions.  

Include Physician Ideas, Issues, and Strategies

Plan management teams are designed to minimize cost by maintaining network uniformity.  Plans, then, try to balance keeping your practice in the network with resistance to change; the result is few issues are ever actually resolved.

While in senior network management, upon request, I met with as many physicians as possible for contract negotiations or to discuss innovative delivery ideas.  For example, in one regional network, I carried contracting responsibility for over 6,000 physicians and 78 hospitals, and a full compliment of ancillary and allied providers.  Relative to the hierarchical decision making structure with which health plans operate, the time available to meet with any physician group is extremely limited at best.  Even so, I routinely met with physicians to communicate, document, and carefully consider issues and strategies that were presented logically and cooperatively through my staff.  Physician input can effect important change with the right approach sustained over time.

Step Ladder Approach

Attempting to demonstrate market force to a senior level plan executive, particularly with staff present from either side, is a common error that invariably leads to less plan flexibility.  Plans often make it difficult to garner prior informal support, which is precisely why a likable, but tenacious, negotiator working on the part of the physician is critical for leveling the balance of leverage, when setting the stage with each level of management prior to formal senior executive meetings.

Physician practices that follow this stepladder approach with plan management are vastly advantaged over negotiations that attempt to bypass lower management.  Months, and some times years, of claims, UR, service coverage, fee schedule, and service agreement terms can easily culminate with a couple of hour-meetings at the network VP, COO or CEO level without favorable changes in contract terms or, most importantly, plan operations.  

Successful planning means that potential solutions have already been informally discussed and tentatively supported within plan lower and mid level management before formal senior level meetings begin.

Value for strong physician acceptance
 
Although health plans are not carbon copies, having negotiated with, or worked for, every national and quite a number of regional plans, I have yet to experience a corporate culture that fully recognizes the potential value for strong physician acceptance of the health insurance industry, policies, or benefit plans.  As a result, network executives spend too much time salvaging easily avoidable disputes, threats of termination, and legal actions with physicians and provider institutions. 

Physician practices receive even less time from network managers relative to institutions because of the smaller direct financial impact to the total claims cost.   A 100 plus physician, multi-specialty group practice in a 2,000-physician network may expect close attention under any circumstance; however, since network executives primarily look at claims risk from a PMPM standpoint, the direct impact is by comparison to institutional cost, minimal. 

This attitude, in part, explains why health plans so often politically miscalculate the comprehensive impact of a physician group termination.  The potential animosity of physicians and practice executives is routinely marginalized as a cost of doing business.  As a result, even physician practices that craft positive local provider relations, seldom translate that relationship into balanced managed care contracts or reasonable payer performance.

My Experience Levels the IPA Table

Many IPA’s can provide or develop cogent practice metrics that offer decisive negotiation advantages when carefully parlayed with payers.  As in direct negotiations, I translate every aspect of your practice’s potential leverage within your IPA into contract performance with the IPA, and subsequently the payers. 

Whether contracting directly or through a messenger model, such as an IPA, or similar contracting entity, Health plans are generally not “out to get” anybody, they simply work to maximize premium and minimize claims exposure on a PMPM basis.

Whether working with me, or another seasoned professional, MMHS is structured to deliver to your practice the ability to negotiate through the health management environment objectively and with exceptional results. 

Principal

David Kern