Expert Forum: How MSOs can help your practice (part 1)

By Erin Graham | July 22, 2019

If independently practicing physicians could make a collective wish, it would certainly be this: Let someone else stay on top of regulatory changes, manage billing, deal with EHRs, decipher quality metrics, and worry about market share so they can get back to patient care.

Hence the buzz about Management Services Organizations (MSOs), which provide contracted practice management and administrative services to individual physicians and group practices. Support ranges from running the entire business side of a practice to taking on tasks like negotiating with payors, quality reporting, managing equipment, finances and HR, and doing mergers and acquisitions.

athenaInsight spoke with leaders at four MSOs for a two-part series. In this first part of edited excerpts from our conversations, they describe their MSO structures and how their services can benefit those in private practices. Please share observations in the comments section or on Twitter at @athena_Insight.

On why the time is right for MSOs

Goran Dragolovic, CEO of Women’s Health USA: OB/GYN providers live under stressful pressures, and an unsustainable burnout rate is creating a greater strain on an already inadequate number of providers. A more aggressive, innovative approach is needed to safeguard this specialty. To have a partner who spends the bulk of its time looking at national trends, seeing how they generate threats or opportunities, and then tailoring ways in which they could be addressed by the group, is increasingly of value to those in private practice.

Scott Disch, National Practice Director of Continuum Health: There’s a lot of receptivity to staying independent versus joining a hospital system. Docs are looking for something where they can control how they run things, get access to lucrative contracts, help manage population health, and not be under the thumb of someone. I’ve always been a big believer that value-based care is a team sport. The health system, independent physician groups, and post-acute providers all require connection points. If independent docs aren’t connected to these entities, it’s hard for them to be out on their own. In order to be successful in value-based care, an MSO is essential to connect these partners, allowing a greater understanding of the population’s spend amongst its medical neighborhood.

On MSO structures

Bret Jorgensen, CEO of MDVIP: We are similar to an MSO by supporting physicians in practice. Our network provides personalized primary care concierge medicine that goes beyond traditional care. Our doctors focus on wellness and preventive care while the MDVIP central organization handles administrative, MSO-like functions and supports them with training, tools, and technology, as well as marketing to keep their practices viable. These MSO-like functions include providing an EHR with training and optimization, personalized patient portal and app, as well as clinical and customer service education. This allows the physician to practice medicine the way they want to.

Dragolovic: We’re equity-backed, which means that we have access to capital that typically has better terms and conditions than what physicians would get on their own. This enables them to access capital they couldn’t get otherwise or would be too risk-prohibitive. This resonates with groups that have a strong commitment to preserving their autonomy and independence, and who want to continue to expand upon the legacy they’ve constructed over the years. They run their practice and we provide capital, administrative support on centralized services, and expertise in executing new opportunities in a highly collaborative way.

Disch: We helped launch a single tax ID medical group (Consensus Health), and the MSO is a holding company for fixed assets. Physicians and APPs become employed by the medical group, and the staff become employees of the MSO. We’re key partners in the centralization of tasks in wicking work off physicians on the EHR side, but also when it comes to technology enhancement. We seek out best-in-show vendors and test out things like remote monitoring, for example, and make decisions on deployment centrally with physician feedback.

Matt Eakins, M.D., COO of Unified Physician Management: We’re different than most MSOs in that we make sure physicians take the central role in decision-making, so the control all stays at the local level with the physicians and administrative teams. We invest a lot in data analytics to create an informed picture for a provider so they can make great health care decisions and be clear on the financial health of their performance.

On other value drivers of the MSO model

Eakins: Beyond faster time to value, cost savings, performance tracking, visibility, and referrals, there’s the benefit of addressing physician burnout. MSOs save them from having to manage so much, and from dealing with all of the complexity. Another big value is being able to differentiate and compete by offering better, more affordable care to patients.

Disch: Financially, a small practice doesn’t have access to the kinds of deals  and contracts that an MSO can get because they don’t have the financial backing — security bonds, private equity — to support them. 

Jorgensen: Our structure is compatible with and supports value-based care. About 20% of our docs are in ACOs. Leaders of ACOs tell us they love the MDVIP docs because our model  decreases  costs, re-admissions and ED visits, improves preventive care and outcomes, and has better patient and physician satisfaction.

On retaining market share

Jorgensen: Since our market is consumers who pay out of pocket, we’ve developed expertise around outreach and retention; namely, digital marketing. Typically, small group practices aren’t doing sophisticated outreach approaches to consumers. It’s critical that we market at a time when patients consider getting active in their health — and convince them to prioritize their health and invest in elevated health care.

Dragolovic: The OB practice is encountering new categories of competitors who are attempting to capture market share of the highly attractive women’s health services market. PCPs are beginning to expand into certain basic GYN services, like pap smears. Retail clinics are emerging as particularly focused on the female patient and tout more convenient access to her primary care and basic GYN healthcare needs. And urgent care clinics are offering after-hour convenience for a broad range of health services, including OB/GYN. With all of these new entrants representing a potential threat to the OB/GYN practice, the environment is challenging the OB/GYN provider to develop new methods of cooperation. We believe that there are opportunities to actually collaborate and partner with PCPs, retail clinics, and urgent care networks so each side gets certain benefits. We need to continually challenge ourselves to ensure that our OB/GYN providers preserve their indispensable role and contribution for all emerging and alternative delivery models.

Erin Graham is a frequent contributor to athenahealth's Knowledge Hub.

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