Contract Lifecycle Management (CLM) is a critical process for healthcare organizations as it helps them manage their complex contracts with vendors, suppliers, and partners. It involves the entire cycle of contract creation, negotiation, approval, execution, and renewal. By streamlining this process, healthcare organizations can reduce contract cycle times, mitigate risks, and ensure compliance with regulatory requirements. As a Docusign implementation partner, we understand the unique challenges that healthcare organizations face in managing their CLM processes. As our clients begin to position themselves for the challenges associated with Health Reform, there will be a tremendous amount of pressure in the provider and payer contracting management area to:
- Reduce cost
- Digitize and protect information
- Harness information within the organization to improve workflow and mitigate risk
Provider contracting and payer contracting are both addressed in CLM by providing a comprehensive framework for managing the contract lifecycle, from initial contract negotiations to contract execution and renewal. With CLM, healthcare organizations can streamline the contracting process, ensure compliance with regulatory requirements, and optimize contract terms to maximize financial and operational performance. By managing provider and payer contracts through a “CLM system like DocuSign“, healthcare organizations can more effectively manage their relationships with key stakeholders, ensuring that they are delivering high-quality care while minimizing financial risk.
- High cost of audit and provider payments
- Inefficient medical expenditures driven by inconsistent/nonstandard language
- Regulatory and provider pressure for increased contract intent transparency.
- Difficulty in finding providers who meet the organization’s specific needs, especially in areas with a shortage of providers
- Claims leakage caused by error prone, manual interpretation, and loading of contracts.
- Limited access to data and analytics that can help organizations identify high-quality providers and measure contract performance
- Challenges in aligning provider incentives with the organization’s strategic goals and objectives
Payer contracting involves negotiating contracts between healthcare organizations and insurance payers. The goal is to establish reimbursement rates and other terms that meet the needs of both parties. Here are some common business challenges with Payer Contracting:
- High administrative costs and declining payer reimbursements
- Variety of paper contracts each covering hundreds of services, each with different rates, terms, conditions, and reporting methodologies
- Breakdown in contract negotiations with managed care companies due to lack of contract visibility
- Lack of data transparency and changing regulations
Key provider and payer contracting benefits to implementing a contract lifecycle management system include, but are not limited to:
- Provider Contracting Benefits:
- High administrative costs and declining payer reimbursements
- Variety of paper contracts each covering hundreds of services, each with different rates, terms, conditions, and reporting methodologies
- Breakdown in contract negotiations with managed care companies due to lack of contract visibility
- Payer Contracting Benefits:
- Ability to track clause usage and terms to allow for reporting on number of denials by category (late submission of claim, failure to pre-certify, bundling of a specific service, etc.) and to see what each has cost over the past several years.
- Better transparency in rates to allow for the ability to negotiate higher reimbursement rates for services.
- Ease of negotiation by allowing for third party paper in addition to your own health plan language to be used in the system.
Our team of experts can help you implement a comprehensive CLM solution that is tailored to your specific needs. With our deep knowledge of the DocuSign platform, we can help you automate your contract processes, enable collaboration between stakeholders, and provide real-time visibility into contract status and performance. Learn more of how we can optimize your Contract Management program by reducing medical cost ratio, improving administrative cost savings, minimizing legal liabilities, and increasing access and visibility into contracts and performance.
