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Providers & Health Insurance Exchanges:  Contracting and other implications for the new marketplace 
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In preparation for the establishment of the Health Benefit Exchanges, which become effective January 1, 2014, health plans will be designing and introducing new products that will serve both individuals and small employers. To support these new products, the health plans will need to contract for the required provider network over the course of 2013 to be prepared for the open enrollment period beginning October 1, 2013. The Exchanges are intended to increase competition and choice, fostering transparency for comparing price, coverage and quality.

For provider organizations, the Exchanges will materially impact the managed care landscape and their response to these changes can have significant implications for their future reimbursement terms and potentially access to patients. Providers should be preparing for these changes by strategically evaluating their options to participate in each of the Exchange products emerging in their market. There are key financial and operational considerations that need to be evaluated in order to determine what is best for your organization and what terms will be acceptable for participation.

With increasing payor activity in the market, providers will be facing some difficult decisions over the next few months. There are multiple strategies to consider along with various scenarios in terms of the volume and financial impact of exchange patients.
Learning Objectives
Participants will be able to:
  1. Review the legislative background and structural models for the state Health Exchanges and the implications associated with each.
  2. Understand how to evaluate the health plan activity in your state and market.
  3. Discuss how best to establish market competitive rates and contract terms.
  4. Further understand the impact of pricing on the exchanges and the potential impact on profitability.
  5. Determine the best approach for structuring the managed care contracts and the key language considerations.
  6. Evaluate potential shifts in payor mix associated with expanded coverage and the introduction of tiered and narrow network products.
  7. Prepare your organization in terms of the operational impact.
Who Should Attend

Interested attendees would include:

  • C-Suite Executives
  • Provider Contracting Executives and Staff
  • Strategy and Business Development Executives and Staff
  • Revenue Cycle Executives and Staff
  • Legal and Regulatory Executives and Staff
  • Health Reform Implementation Executives and Staff
  • Payer Relations Executive and Staff
  • Provider Relations Executive and Staff
  • Business Intelligence Executives and Staff
  • Other Interested Parties

Attendees would represent organizations including:

  • Hospitals, Physician Groups and Health Systems
  • Provider Networks
  • Health Plans
  • Third Party Administrators
  • Other Healthcare Providers
  • Provider Consulting Organizations
  • Pharmaceutical Organizations
  • PBMs
  • Other Interested Organizations
Providers & Health Insurance Exchanges: Contracting and Other Implications for The New Marketplace 
  Individual Registration Fee: $195. webinar flash drive with video syncing slides and recorded audio, plus presentation pdf file: $45 for attendees; $260 for non-attendees after the event. Register online or download the event brochure.
Register Now   Corporate Site licensing also available. Click here to register or call 209.577.4888 We look forward to your participation in this event!
James P. Donohue
James P. Donohue,
Senior Manager,

Mr. Donohue is a Senior Manager in ECGís Boston office and works in the firmís Contracting and Reimbursement practice. With nearly 20 years of experience in the healthcare industry, he has been assisting provider organizations with issues related to payor reimbursement and revenue realization, as well as evaluating and executing strategies to project and improve upon their financial performance.

Mr. Donohue has conducted dozens of consulting engagements for clients, focusing on managed care contracting, innovative and conventional reimbursement strategies, business operations, and strategic planning. Prior to rejoining ECG in 2008, Mr. Donohue served as an independent consultant with clients that included Partners HealthCare System, Inc.; UMass Memorial Medical Group; Neighborhood Health Plan; and others.

Mr. Donohue holds a master of business administration degree, with a concentration in healthcare management, from the Boston University Graduate School of Management and a bachelor of arts degree from Boston University.

Ken R. Steele
Ken R. Steele,
Senior Manager,

Mr. Steele has extensive experience in managed care and hospital senior leadership positions, as well as in contract review, analysis, and negotiations. Mr. Steele has had responsibility for 20 hospitals with over $1 billion in annual managed care revenue. He has led many hospitals and hospital systems in substantially improving their contract reimbursement rates, contract language, and revenue cycle management.

In addition to managed care, Mr. Steele has a comprehensive background in hospital operations, having held multiple hospital leadership positions, including CEO. He has successfully managed a hospitalís financial and strategic turnaround in a large, competitive market.

Mr. Steele holds a master of health administration degree from the program in hospital and health services administration and a bachelor of science degree in business administration, both from The Ohio State University.

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