Managed Care
The Abaris Group is an acknowledged authority on managed care issues relating to emergency and ambulatory services. Mike Williams, The Abaris Group's president, has conducted extensive research on managed care and is a nationally recognized speaker on the impact of managed care and proactive provider strategies. Mike was the lead speaker at the American College of Emergency Physicians (ACEP) conference "Effective ED Provider Strategies for the Managed Care Emergency Department" held in Las Vegas (2/99) and Miami (5/99).
The Abaris Group staff has worked with a variety of organizations to understand the managed care industry - physician groups, hospitals, prehospital providers, etc. Our firm has conducted four major studies for managed health plans. For example, The Abaris Group recently provided consultative services to a large health plan in Connecticut (with membership also in New York) regarding optimizing their Medicaid payments. This entailed reviewing and evaluating payment procedures, developing a global payment scheme and developing an "auto-authorization" policy for emergency services.
Key Managed Care Services
- Carve out strategies
- Contemporary charge systems (e.g., case rates, global fees, capitation)
- Contract analysis and strategies
- Contract negotiation
- Discount fee structures calculations and recommendations
- Health plan payment review
- Legal alternatives
- Payment strategies
- Prompt payment provisions
- Successful contract templates
- Strategy seminars and workshops
Featured Projects
California ED Diversion Project
With support from CHCF, The Abaris Group conducted the California ED Diversion Project, which analyzed ED and emergency medical services (EMS) diversion in all 31 local EMS regions; inventoried best practices; and had a sample number of EDs and local EMS agencies participate in a collaborative to reduce diversion in their region. The California ED Diversion Project Report and Appendix can be viewed and downloaded from the project's web site.
Marin County Healthcare Safety Net Study
The Abaris Group worked closely with Marin County to help them assess their healthcare safety net. The study analyzed the healthcare safety net services in Marin, including an assessment and projection of current and future heatlhcare utilization. Click the hot link below to learn more.