The DMPC now offers certification for Contract Design and Negotiation, specifically for contracts involving care management vendors (disease management, complex case management, nurse triage lines).

This certification is open only to payors and consultants, not vendors. The certification stays with the individual, so that when the individual leaves an employer, the certification goes with him or her.

Applicants must submit three contracts for which they themselves were the primary point person in negotiation. (Prices on these contracts may be omitted, if preferred.) At least one of the contracts – the most recent – must reflect “best practices” in twelve of the categories below, ten if nurse triage line is not included. There may be good reasons for omitting some of the clauses, which is why compliance with all best practices it not needed.

Application fee for lifetime certification is $500, waived if your organization is a DMPC Retainer-level member.

It is assumed that the standard disease management contract clauses are included, such as reporting requirements. It is also assumed that standard legal language is included, such as breach-of-contract cures or a merger triggering the option to terminate. Because of these assumptions, the clauses on which certification is based are specific to disease management contracting:

1. ASO — Is the level of vendor sales effort and additional cost (if any) for ASO accounts, by size, explicit? (It may be that there is no additional cost and that the sales effort is totally the responsibility of the health plan. This should be explicit too.)
2. Asthma — Does the contract capture the implications of the mathematical impossibility of saving money in asthma? (Either by making it “opt-in” for at least the insured population or excluding it from any risk-based pricing)
3. Definitions — Are terms such as “engaged” and “participating” and “disease-eligible” fully defined?
4. Effort — Is it clear that the vendor is expected to complete a certain number of phone calls? (It is not necessary to maximize the number of phone calls, because some vendors may convince a payor that fewer phone calls to the “right” members is a better strategy.)
5. End-of-Contract (a) — Does the contract anticipate the likelihood of a change in vendors (or a move to in-sourcing) in keeping the 800-number as payor property?
6. End-of-Contract (b) — Does the contract require the current vendor to cooperate fully with any new vendor or internal program, including (to the extent allowed by HIPAA, which should be the full extent) the provision of records for the new vendor?
7. End-of-Contract (c) — Does the contract anticipate and prevent or limit the vendor’s ability to “go after” a payor’s ASO accounts on its own if and when the contract ends for whatever reason? (A blanket prohibition is not necessary. It is necessary only that this contingency be addressed, at least modestly in the payor’s favor.)
8. End-of-Contract (d) — In the event that the payor is not ready with a new solution yet, is it clear that the existing contract is automatically extended (not renewed), and that the extension is at the same price?
9. Most Favored Nations — Does this clause exist and is the wording consistent with DMPC standards?
10. Not-for-Cause Termination — Has the payor reserved this right? Is it clear that there is no not-for-cause termination fee (other than possibly a waived implementation fee)? Is the interval before not-for-cause termination strictly defined?
11. Nurse Triage Line (a) — Does the measurement of outcomes (if tied to price or risk penalty) not involve asking callers whether they would have gone to the emergency room?
12. Nurse Triage Line (b) — Does the measurement of price or re-pricing include dividing the number of phone calls by the total fee?
13. Time to Contact — Does the contract explicitly limit the amount of time between when the vendor gets contact information and when the initial contacts are made?
14. Validity (a) — Is the Regression to the Mean adjustment consistent with DMPC standards?
15. Validity (b) — Is there a “plausibility check” consistent with DMPC standards?
16. Validity (c) — Is there an absence of outcomes measurement clauses known to be invalid?