The 4 Approaches of Management Service Organizations

It is not uncommon for hospitals or other third-party providers to establish Management Service Organizations in order to take care of specific areas of a physician's practice. Traditionally, a medical practice's non-clinical operations are outsourced to an MSO. They take care of business operations such as administration, staffing, marketing, insurance, and financial reporting. The technological issues that plagued MSOs years ago were mitigated with developments in the introduction of electronic health records (EHR). The Affordable Care Act (ACA) and accountable care organizations (ACOs) incentivize doctors to exercise influence on insurers and run more effectively.



As They Are: How an MSO Works

MSOs usually have contractual arrangements with practitioners and clinical practices as outsourced providers. To do the same tasks, MSOs sign contracts with physician groups. Physicians' suppliers and/or payers may contact one person. In exchange, the MSO's specified fee must also be paid.

The supplier discussions for 10, 20, or more medical offices will be handled by the MSO if it manages buying for its doctors. The MSO is able to get better pricing than organizations can get on their own because of this arrangement. MSO staff execute paperwork, bill, and collect receivables, which may result in more insurance reimbursement and lower expenses.

MSOs used to buy practices and rent back office space and equipment. These arrangements become less typical, since an MSO acquiring the practice has more potential difficulties than offering administrative services does. In most circumstances, exceptions exist, but it's best to avoid these setups.



4 Most Critical Aspects of the Services

Providers may concentrate on delivering high-quality treatment to patients when administrative and managerial activities are centralized by MSOs. It is up to the risk-bearing organizations to decide how much, if any, of the services provided by MSOs they want to purchase in complete or on an as-needed basis. Some of the most important aspects that Management Service Organizations offer to healthcare organizations are:

1. Better Consumer Experience

MSOs can aid medical offices by organizing patient scheduling. Patients obtain treatment faster, and efficient handoffs between professionals improve the patient experience. With their aid, clinicians can easily interact with patients despite cultural and language barriers as well as boost patient understanding, engagement, and compliance. Using MSOs, hospitals may employ care managers to monitor workflows, follow up with patients, explain drugs, and schedule follow-up visits. These services give a high degree of personal attention, which is crucial for the chronically ill, elderly, or inexperienced patients.

2. Utilization Management
MSOs handle patient eligibility and enrollment, a typical managed care task requiring data exchange between payer plans and provider organizations. Contracting with health plans necessitates the regular exchange of eligibility files, the appointment of skilled administrative personnel, and the need for IT assistance. A suitable workforce level is required to respond quickly to service denials. Additionally, MSOs employ care teams and nurses to oversee the clinical aspects of this procedure. It’s necessary to keep accurate, auditable records of these actions making them available to plan and regulatory reviewers regularly. Due to the MSO's size, smaller physician groups are able to receive this level of professional assistance.

3. Clinical Information

Capitated medical groups must disclose encounter and claims data to health insurance. MSOs have experienced employees and up-to-date claims processing infrastructure that smaller medical groups don’t have. MSOs help provider companies educate physicians and employees on appropriate reporting and remediate data errors for improved accuracy. Capturing, translating, and transmitting healthcare data from providers is a challenging process. A strong MSO can turn clinical data into meaningful information for population health management, network management, and risk assessment.

4. Administrative and Risk Management

Only licensed clinical practitioners can join provider groups. Many minor physician groups are shareholder medical groups made up of doctors. MSOs have the size to recruit financial, actuarial, and IT experts. The MSO assesses risk-based, capitated contracts with payers. Risk-bearing organizations (RBOs) must disclose financial solvency quarterly and follow corrective-action plans for financial and clinical operations. MSOs aid in compliance and offer legal and operational help.

What It Means for MSOs to Adapt to Modern Technologies

Major barriers to entry into the market for providers willing to accept the risk have been put in place by a broad group of physicians. To avoid financial risk, many physicians would rather stick with a fee-for-service (FFS) arrangement. However, several physicians perform better and contribute more to healthcare when they take financial responsibility for the results of their patients. Medicare's move away from FFS payment is due to the value-based payment paradigm.

QuickCap 7 (QC7) provides MSOs with a customizable platform that can do both basic and complex administrative tasks while allowing MSOs to save unnecessary fees and expenditures. Management Service Organizations run efficiently and smoothly thanks to QC7's straightforward but unique features, including case and claims management, authorization and referral, reports generation, and many more.

An administrative integrated technology partner that shares your healthcare goal may help your company thrive. QC7 can help you streamline procedures, enhance workflow efficiency, and increase income streams no matter where you are in your business journey.



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Reference:

Lawton R. Burns and Mark V. Pauly, Accountable Care Organizations May Have Difficulty Avoiding The Failures Of Integrated Delivery Networks Of The 1990s.  11 Health Affairs 2407 (2012).