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The New Healthcare Managed Service Organization · What are Healthcare MSOs? A healthcare MSO is an...
Transcript of The New Healthcare Managed Service Organization · What are Healthcare MSOs? A healthcare MSO is an...
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The New HealthcareManaged Service Organization:
Just What the Doctor Ordered
Presented by
James D. Swift, M.D.Chief Development Officer, MEDNAX
Ann BarnesPresident and CEO, MedData
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Agenda
4 H o w M S O s B e n e f i t H o s p i t a l s
S e r v i c e s b r e a k d o w n o f M S O s3
W h y a r e M S O s I m p o r t a n t t o H o s p i t a l s ?2
W h a t i s a H e a l t h c a r e M S O ?1
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What are Healthcare MSOs?
A healthcare MSO is an organization that provides non-clinical services to providers to enhance revenues, contain costs and improve quality.
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Practices - receive significant administrative assistance.
Physicians - maintain increased level of autonomy.
Patients - experience improved service engagements, economies of scale /cost savings
W H O T H E Y I M PA C T
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Market Dynamics
I N C R E A S I N G N E E D F O R
SOLUTION
Healthcare reform creating
Complex Reimbursement Challenges
Healthcare payment process
Structured Around Insurance Providers
Poor collections of patient balances:
19% vs. 75%
PROVIDER CHALLENGES
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Healthcare reform creating
Outsourcing
Increases in patient responsibility
3% 35% 50%
Increased Medicaid driving need for
Onsite Enrollment & Eligibility Services
RCM/PATIENT TRENDS
PROVIDERS
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What Hospital Leaders and Physicians Want
Preserve clinical autonomy
Create a practice that is efficient, high quality, and
patient –centric.
Patients to remain loyal to the health system
(increasing stickiness).
Solutions to their practice coordination and complexity
challenges.
To mitigate compliance risk.
Vehicles to strengthen hospital-physician alignment .
To offset complex reimbursement challenges of
Healthcare reform.
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Building Partnership: External Forces at Work
• Increasing financial pressures to manage challenging market conditions
• Healthcare consumerism and the importance of patient experience
• Healthcare reform legislation
• Exponential growth of RAC firms
• Growing number of payor plan designs
• Greater coding complexity
• Lower reimbursement rates
• C-suite seeking to consolidate vendors
• To preserve clinical autonomy and help create a practice that is efficient, high quality, and patient-focused.
• Solutions to their practice coordination and complexity challenges.
• Vehicles to strengthen hospital-physician alignment.
• Vendor consolidation
PROBLEMSF A C E D B Y H O S P I T A L S & P H Y S I C I A N S
SOLUTIONSW A N T E D B Y H O S P I T A L S & P H Y S I C I A N S
MSO
Org
aniz
atio
ns
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MSO Services Breakdown
Coding & Clinical Documentation
Compliance Audit & Training
Charge Capture & Reconciliation
Billing / AR Follow-Up
Credentialing / Provider Enrollment
Payor Contracting
Compliance
HR
Facilities
IT
Payroll/Finance
Scheduling
Clinical Effectiveness
Physician Referral Management
Registration
Pre-Authorization
Financial Counseling
Point of Service Collections
Patient CommunicationPATIENT ACCESS &COMMUNICATION
ANALYTICS & CONSULTING
PRACTICE ADMINISTRATION
REVENUE CYCLE MANAGEMENT
Practice Growth
Patient Engagement
Benchmarking
Clinical Effectiveness
Population Health Analytics
Labor Productivity
Physician Compensation Design
QUALITY
PATIENTSATISFACTION
REVENUE
COST
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How MSOs Benefit Hospitals
QUALITYPATIENT
SATISFACTIONREVENUE COST
Optimize revenue capture, procedure mix and
promotion capabilities.
Help achieve better results at lower costs
Provide improved expertise