ABSTRACT
Managed-care agreements for Independent Practice Associations, Physician Hospital Organizations, Management Services Organizations, and Accountable Care Organizations are ever-increasingly being signed as full-risk, percentage-of-premium, capitated contracts. When a Health Maintenance Organization (HMO) signs an agreement with one of these groups, the capitation paid is likely to be a large sum of money each month. Therefore, contracts and agreements of this type involve heavy liability on the part of the HMO to do the necessary due diligence with the organization in regard to economic credentialing. Many managed-care agreements contain specific performance language with regard to the provision of covered services and the group’s performance. The chapter aims to share with physicians some model language from contracts that when they see them, they will not become unnecessarily surprised.
