Management of Health Plan Contracts
MAG provides a wide array of services to help its clients cost-effectively manage their health plan contracts. These services can be broadly categorized as medical management, contract management and general administrative services.
MAG provides a number of medical management related services. One of the most important services MAG provides for its clients is generation of periodic performance reports based on health plan claims data.
Other medical management related services that MAG provides for its clients include:
- Consultation concerning the appointment of a medical director who will address utilization and cost issues
- Development and use of voluntary pharmacy formularies and practice guidelines
- Establishment and operation of a physician rotation program to ensure appropriate use of inpatient hospital services
- Consultation with medical director and IPA/PHO board regarding changes to primary care physician and specialist withhold levels
- Consultation regarding aggregate and physician-specific utilization, cost and financial reports provided by health plans
- Communication strategies to educate and inform physicians about performance
MAG also provides a number of contract management services for its clients including the following:
- Act as the primary liaison between the IPA/PHO leadership and health plan staff concerning any issues that arise with respect to the contract
- Develop and review reports to ensure that health plans are applying correct withhold amounts on primary care physicians, specialists and other providers
- Analyze settlement reports to ensure they are accurate
- Act as the primary source for contract questions
- Perform general administrative services for its IPA/PHO clients
Data Services