Group of doctors and nurses The transition to managed care begins with project management and buyin.

The transition to managed care begins with project management and buyin.

Let’s dive into all things project management. Many healthcare organizations are currently transforming from fee-for-service to flat rate payments as they evolve into Managed Care Organizations, but the path to becoming an MCO can be paved with difficulties from a financial, HR, and operational perspective.  Here is a quick list of “lessons learned” that Managed Care Organizations should consider during their transition.

Project Management

The complexity of morphing an organization from a fee-for-service entity to a Managed Care Organization is a significant shift.  Numerous aspects of the organization, from corporate culture- to authorizations and claims will be impacted.  These changes can be magnified if multiple organizations are merged into one Managed Care entity.

  • Designate a project manager with the singular focus of implementation – do not append this role to any others
  • Require the entire leadership team to become familiar with Managed Care Operations.  If there is a State issued Managed Care Contract, require all members of senior leadership to become acquainted with the nuances of the contract.
  • Do not silo knowledge between the clinical and the non-clinical.  The organization will need to operate as a seamless whole, so the faster you can integrate all aspects, the better off you will be.
  • Have frequent workflow meetings.  Use these meetings as an opportunity to dive down to the ground level to identify where departmental overlap occurs.  Identify all handoffs and diagram everything from a process flow perspective.
  • Establish your budgets early and discuss and collaborate with Clinical teams and Finance teams to tie all of the pieces together.

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