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