4 Healthcare Contract Lifecycle Management Scenarios Solved

The healthcare industry provides services to treat patients with curative, preventive, rehabilitative, and palliative care. Healthcare organizations need to manage various types of contracts, which are rife with critical and sensitive data that are even more complex due to the regulations inherent to the industry.

Winning healthcare organizations trust healthcare contract lifecycle management (CLM) software to assist with managing these contracts and data. To that end, here are four example scenarios with hypothetical organizations that elucidate challenges in contract management for healthcare, solved with an effective contract management solution!

Scenario #1

CareCare is a health group that provides holistic care via a network of hospitals, wellness centers, and community outreach programs – emphasizing mental and physical well-being. CareCare’s healthcare contract lifecycle management professionals needed an easy way to review procedures that physicians code into their system to bill insurance companies. They also needed to manage rates contracted with insurance companies and update and amend contracts.

Luckily, CareCare decided to adopt contract management for healthcare with a robust healthcare CLM solution.

The solution helped them to easily manage relevant contracts drafted by them or introduced via third-party paper. CareCare retained a bank of preferred clauses and templates within a pre-approved language library.

They were able to take third-party managed care agreements and payer agreements and auto-redline clauses – such as scope of services, reimbursement terms, and credentialing and licensing requirements – with the power of contract intelligence so that only preferred terms remained.

CareCare was also able to extract key metadata from third-party contracts and store it within a neat and tidy contract record with both configured and out-of-the-box fields for healthcare contract lifecycle management.

CareCare found fields and data tables for contracted products (HMO, PPO, etc.) and CPT/HCPCS codes and rates especially helpful. Adding amendments was incredibly simple with automated version tracking, redlining, and comprehensive audit trails.

These are just a few highlights of CareCare’s experience with contract management for healthcare with a trusted CLM solution.

Scenario #2

Vitaly Health Network is a global healthcare provider focused on affordable and accessible care – including telemedicine services. For managing physicians and providers, Vitaly needed to capture key information related to background and payment.

They also needed a better means of tracking key dates related to obligations and expirations. For security, they needed information to be accessible only to HR. In short, Vitaly needed a one-stop shop for contract management for healthcare.

In order to meet their needs, Vitaly chose a reputable healthcare contract lifecycle management solution.

With internal templates for physician agreements and provider agreements, Vitaly Health Network was able to streamline the process of drafting these contracts – complete with preferred terms around compensation models, non-complete clauses, clinical autonomy, call coverage, and more. HR was able to leverage metadata fields and data tables to track:

• specialties.
• credentials.
• salaries.
• bonus information.
• locations physicians are employed.

If this information needed to be recalled, Vitaly Health Network’s HR reps could simply search down to the field level – complete with search history, saved search, and “Did you mean…?” functionality. They could also easily configure permissions down to the user or user group level so that only HR could access this sensitive information for better contract management for healthcare.

Scenario #3

Tophocks Medical Solutions is a comprehensive healthcare organization that specializes in cutting-edge preventative care and chronic disease management – with a focus on integrating technology such as wearable devices and AI diagnostics.

Tophocks needed a way to purchase goods and services, issue RFPs for purchases over $25,000, and track spend versus budget. To solve these needs, Tophocks went with healthcare contract lifecycle management software.

Based on what they were purchasing, Tophocks could now easily draft and manage procurement and purchase agreements such as:

• consulting agreements.
• master service agreements,
• software agreements.

They could centrally track vendor details, contract amounts, budget amounts, and other standard out-of-the-box and configured fields. Tophocks could also report on these fields – such as an ad-hoc report for contracts expiring within the next ninety days. They could also use data tables to track obligations, deliverables, and SLA (service level agreements).

Furthermore, they could create RFP records straight from contracts and vice versa! This is just a scratch at the surface of Tophocks Medical Solutions could do with a solution for contract management for healthcare sectors.

Scenario #4

Townley Health Innovations is a multinational health service provider that combines hospital systems, pharmaceutical research, and insurance solutions to offer comprehensive care across various continents – focusing on continuity of care.

They needed a way to quickly and accurately determine if a vendor had access to PHI and PII. Thankfully, a leading healthcare contract lifecycle management software provider had their back.

In addition to purchasing agreements with vendors, Townley could easily leverage pre-approved templates for business associate agreements (BAAs). As such, they could include and negotiate with pre-approved language around:

• permitted uses and disclosures of PHI.
• safeguards to protect PHI.
• reporting of breaches or improper disclosures.
• subcontractor obligations.
• right to audit and inspection.
• return or distruction of PHI.
• HIPAA amendments.

Additionally, they could leverage a neat and tidy metadata field page for a purchase agreement.

A simple “Yes” or “No” field could be configured to autogenerate a BAA template via a pre-configured workflow! Townley enjoyed many other leading contract management for healthcare features, but this is just a helpful example.

If you like any of the functionality that our scenario example companies used and you want to see more, book a free demo of CobbleStone Contract Insight^® healthcare contract management software today!