Whatever name they go by – “value based,” “incentive based,” “patient centered,” “population health management” – incentive-based contracts will yield improved health outcomes. However, it doesn’t happen overnight. There are inherent risks and potential pitfalls that should be avoided to keep them from negatively impacting the longevity of the MSO/IPA/PHO and physician-owned businesses.
In order to succeed with incentive-based contracts, physicians must partner with patients to effectively manage all aspects of their health care. The MSO (Management Services Organization) must manage the physician’s expectations and educate him/her with respect to MRA coding, HEDIS and what management of a customer’s health care conditions truly means. An engaged health plan should want the MSO to succeed and provide tools, guidance and expertise to ensure the relationship being built is a long term success to both of the partners. The MSO must have centralized service capabilities, offer day-to-day involvement and oversight for the daily hospital census; provide management of chronic conditions; offer HEDIS and coding–CPCs–education, audits and review; and outbound/inbound scheduling services. Additionally, HR, finance, contracting, purchasing, etc. should be centralized to gain consistency and efficiency of cost and process.
Leave A Comment