Raising the Curtain on
Management Services Organizations

They are the engine for the effective and efficient management of administrative, non-clinical tasks on behalf of physician organizations and risk-based entities.

From processing large-scale claims to supporting insight-driven decision-making, these organizations provide a range of services and capabilities that physicians could not otherwise afford to employ on their own, making them a laudable partner in their quest for value-based improvements.

According to recent research, value-based, innovative care delivery models tower over medical organizations that pursue fee-for-service arrangements.

This is a significant factor that makes healthcare organizations turn their heads to MSOs even more, raising the curtain and unlocking better quality of care, lower operational costs, and increased patient satisfaction.

Partnering with a Management Services Organization

Setting up a new MSO or connecting with a high-performing one is not an easy endeavor. Yet, there are some basic elements worth describing to fully understand how these organizations operate.

A typical MSO arrangement starts with an initial contracting between a health insurance (payer) and a physician organization in which the former pays capitation based on the number of members who receive care.

Then, a second arrangement takes place between the physician organization and a MSO, where the latter takes responsibility for fulfilling all the non-clinical, administrative functions for an agreed percentage or management fee, based on the number of members who receive care.

Such a relationship enables MSOs to assume a set of management expectations for which expertise is crucial.

From anticipating business needs to bridging care gaps, the amount of responsibility and accountability pose a real challenge for MSOs, particularly when it comes to securing patient-centric outcomes.

However, MSOs do not just exist to quickly solve a business conundrum.

Physician groups are also responsible for validating goals, assessing various functions, and setting up the pillars to a smoother transition of partnership before formalizing a contract.

Another important prerequisite lies in the analysis of the business environment, which includes market assessment, organizational readiness, current infrastructure assessment (including IT), resource management, review of contracts with vendors, just to name a few.



How Management Services Organizations Create Value

Despite its complexity, MSOs exist to provide not only the ideal administrative structure physicians need to stay in business, but also the expertise needed to create value at every step of the patient journey.

Below, we grouped six areas where MSOs can create value upon performance.



Patient Journeys

MSOs are valuable allies for optimized patient journeys. They possess the bandwidth to coordinate various aspects of patient care, ensuring smoother interactions, better provider-patient relationships, reliable tracking of admissions and discharges, and accessible documentation of patient progress.

By doing so, MSOs infuse efficiency and effectiveness into care coordination to achieve better results.



Utilization Management

Determining eligibility and enrollment can be excruciating for organizations with a poor focus on data. High-performing MSOs typically employ experienced administrative staff and IT support to manage loads of eligibility files, as well as denials at the highest level of accuracy.

In many cases, these organizations work with more than one health plan, which requires deeper attention to detail and well-maintained patient records for decision-making. Data management and competency make all the difference.

Evaluating clinical information

Physicians do not have the time nor the expertise to evaluate each claim submission, as they tend to be overwhelming and disrupting.

At this level, MSOs rely on data exchange to process various claims in the most efficient fashion. Not only do they process large volumes of data for handling claims, but they also build reports with actionable information to assist in decision making.

Administrative and Risk Management

As value-based healthcare becomes the norm, MSOs help physician organizations evaluate each risk-based capitated contract that they have with other payers.

Part of their services is to ensure physician organizations are solvent enough to stay in business. Not to mention that they are also capable of providing legal and operational support to ensure sustainable compliance.



Network Alignment

Delivering care with a patient-first philosophy goes beyond commitment, and meeting capacity is a must before getting started.

By offering administrative support, MSOs enable organizations to not only recruit the right staff to perform various tasks and meet capacity, but also provide learning/training opportunities to achieve team cohesiveness.

In addition, MSOs can also contribute to further network expansion as they act as magnets for future partnerships. Smaller physician organizations are typically laden with administrative and management responsibilities that preclude them from meeting their goals. 

Joining a larger network of providers makes complete business sense for these smaller actors. From recruitment to expansion, MSOs facilitate an environment where business goals and purpose are perfectly aligned with execution.



Population Health Management

It can be time-consuming for physicians to go through mountains of data to better manage large patient populations.

From identifying social determining factors to accessing physician performing data, there is a growing pressure for physicians to become insight-driven actors.

And that’s when MSOs make all the difference. They provide a sophisticated IT infrastructure to efficiently categorize patients and determine best practices across the care spectrum. 

By using tech-enhanced tools, MSOs are now able to implement patient outreach programs for streamlined patient experiences, prioritizing preventive care, and reducing costs, all of which are extremely valuable in the delivery of exceptional, value-based care.



Effective Support Team

MSOs establish a dedicated support team that helps physician groups to navigate the various quality and auditing requirements to stay ahead of the curve in managing care.

They look into routine tasks and configure workflows that are suitable to increase operational efficiency while being transparent about their practices.

In addition, MSOs assist organizations on best digitization practices to simplify workflows. For example, a support team could encourage physicians to use EMR systems to access and analyze patient information without communication delays.

There have been cases where one-on-one meetings and training were offered to clarify guidelines from external payers and other healthcare organizations.



Case Management

Coordinating care can be overwhelming for physician groups with limited resources. That’s why MSOs assist in the deployment of care coordinators to ensure the required supplies and equipment are available to physicians in every moment of truth.

At every transition, care coordinators also deliver medication reconciliation and track patient’s health in order to avoid potential readmissions.

There is even a huge need for MSOs to pursue preventive care and monitor high-risk patients - either admitted or post-discharged members. By following up with recovery, MSOs ensure providers deliver superior value throughout the care continuum.



Introducing QuickCap to Power Your Management Services Organization

MSOs are designed to help physician organizations achieve success in healthcare delivery with strong business acumen. Yet, the ongoing push towards positive outcomes requires an all-in-one administrative and management system that can turn fragmented tasks into highly efficient workflows.

To meet those demands, our QuickCap solution offers the most sophisticated built-in platform, tools, and features that can be easily customized according to your needs.

From data management to efficiency-enhanced workflows, we offer everything you need to keep your MSO running smoothly.

If you wish to learn more about QuickCap, feel free to contact us. We are glad to help you accomplish your organizational goals.