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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

What is a Healthcare MSO?

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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

Why are MSOs Important to Hospitals?

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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

z

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

MSO: Services Breakdown

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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

How MSOs Benefit Hospitals

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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

Q & A

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