How to Design Your MSO for a Successful Operational Start

How MSOs Became a Strong Support Partner for Providers

MSOs support numerous administrative processes to help keep healthcare providers and practitioners focused on care delivery. Management operations are integral to healthcare. These include data capturing to determine contracting parameters, provider eligibility, credentialing requirements, and other essential processes.

Government agencies are placing more liability on health plans that prompt providers to effectively manage risks. With healthcare being their primary focus, providers are increasingly becoming reliant on MSO services. Some of the most outsourced processes now include claims adjustment, authorization workflow, and case administration.

MSOs play a vital role in value-based care and population management. In the same way,  both aspects require updated technology and modernized infrastructure. With that, MSOs are in an enviable position as key industry players since they provide structured technological innovations.

Determining Factors for a Strong Operational MSO

The services provided by MSOs save their partner organizations' resources. Depending on the agreement laid out in their contracts, MSOs can negotiate with payers, facilitate electronic health record (EHR) management, and even handle information technology (IT) services. Some MSOs specialize in certain non-medical aspects, while some can handle all non-clinical processes.

However, not all MSOs are set up for success since several factors have to be in place in order to determine their operational readiness. Some operational readiness components that deal with the timing, delegation, and audits of a proposed MSO have to be taken into consideration, including:

• Utilization management (UM) that includes payers’ health cost-benefit management using value-based guidelines
• Population health management (PHM) that is aimed at improving the clinical health outcomes of a defined cluster of individuals
• Claims management processes encompassing the entire life cycle of the patient claims
• Compliance auditing that increases organizational productivity through process gap closures
• Care coordination and delivery through organized communication strategies targeting vital patient outcomes



Since MSOs are often outsourced non-medical administrative support, structuring the process flow is extremely important to facilitate productivity. With that, MSOs are essentially gateways to assisting providers to focus more on patient health quality and outcomes.

MSOs Benefit by Beginning with an End in Mind

Undoubtedly, MSOs offer a variety of services that appeal to risk-bearing entities. The said services encourage service acquisition in totality or on a piecemeal basis. Centralizing the administrative and managerial functions of practices, MSOs leverage resources efficiently if built from the ground up. This allows physicians to maintain or increase their level of autonomy to elevate the health outcomes of patients. 

Determining the effectiveness of MSOs can be indirectly reflected in the providers they serve. Most often than not, many successful practices rely heavily on the efficient output and performance of thriving MSOs. As such, MSOs need to rely on a comprehensive value-based administrative healthcare solution as a partner to their work processes. This is incredibly vital for emerging MSOs who have yet to figure out how to optimize their system. For operational MSOs, their experience will provide them with greater direction in using healthcare solutions.

Meeting MSO demands, MedVision developed QuickCap 7 (QC7), its most sophisticated, integrated, and comprehensive administrative platform for healthcare professionals. The intuitive yet thoroughly innovative features and tools found in QC7 keep MSO processes seamless, streamlined, and simplified with powerful functionalities such as:

• Case management modules capable of handling UM and PHM requirements
• Authorization and referral capabilities to manage, process, approve or cancel related requests
• Preemptive and proactive communication and clinical alerts to improve health outcomes
• Claims management to adjudicate or reject requests, with proprietary custom configurations
• Reports generation to monitor compliance, security, process gaps, and profitability



With nearly three decades of supporting various care organizations, MedVision is consistently recognized as one of the top providers of healthcare solutions. A continuous product of technological development, QC7 produces impactful and positive outcomes for every MSO partner.

Write your success story with QC7!



Reference:

https://www.dmhc.ca.gov/Portals/0/Docs/DO/Agenda%20Item%208.%20APG%20MSO%20Whitepaper%201%2025%202019.pdf