MSO Partnerships: How Payers Benefit

Providing top-notch patient care is the central focus of any primary care practice. However, the business side of running a medical office is much more complicated. Behind the scenes, office staff tackle a multitude of administrative tasks that frequently become overwhelming and potentially pull time from patient care. 

Management services organizations (MSO) can help ease this burden. MSOs provide non-clinical assistance to medical facilities, helping to streamline the business end of practice management so providers can spend more time focusing on patients. Through contracted relationships, MSOs assume responsibility for coding compliance, data analytics and insights, claims and utilization management, and more.  

MSOs also offer quality improvement resources such as comprehensive care management to help providers close care gaps and meet quality metrics. These types of services are particularly important as healthcare pushes toward value-based care (VBC). 

However, medical practices aren’t the only entities that can benefit from MSO partnerships. They can also help payers engaged in value-based contracts. 

Why Should MSOs Matter to Payers? 

Payers share financial risk with physician practices, so MSO partnerships can offer several operational advantages: 

• Increased patient access: An MSO can consolidate all payer contracts to expand patient access significantly. This arrangement allows payers to build on existing data and resources, including member stratification, care management programs, claims data across providers, and electronic health record connections. As a result, it becomes easier for payers to integrate with provider workflows. 
• Predictable outcomes across offices: Many providers may lack the infrastructure to succeed on their own in a value-based contract. An MSO can take over utilization management, care management, and risk adjustment. By assuming control of these activities, MSOs can eliminate blind spots. This ensures that functional and cost outcomes are consistent across all contracted clinics.
• Better physician contract retention: Providers are more likely to maintain or renew a contract with a payer if they benefit from the arrangement. An MSO works with both payers and providers to align mutual goals, ultimately increasing stable provider contracts. 

“Overall, partnerships with MSOs enable payers to provide more innovative, outcome-driven solutions that can improve quality of care and enhance providers’ capabilities,” says Broadus Sheffield, divisional vice president of payer relations at Innovista Health. 

Benefits of MSO Partnerships to Payers

Succeeding in value-based care takes a cooperative approach. When payers and MSOs work together, the partnership improves the payer’s ability to collaborate with providers, standardize processes, and align incentives. Through this relationship, payers help support providers’ efforts to:

• Free up more time to focus on clinical practice and patient care 
• Increase efficiency by creating uniform systems for electronic health records, billing, scheduling, and staff performance  
• Keep overhead costs low by negotiating better rates for supplies and equipment 
• Negotiate higher reimbursement rates to boost profitability 

According to Sheffield, MSO partnerships can create a more streamlined, transparent VBC environment, allowing providers to deliver a better care experience at a lower cost to both the payer and the patient. 

MSOs Help with Physician Recruitment 

Growth and expansion are common goals across all lines of business—and the health insurance market is no different. MSO partnerships become useful in this regard, too. When an MSO understands a payer’s expansion goals, it can help develop a provider network in areas where payers are interested in expanding. 

Currently, there are two big opportunities for recruiting providers. As of 2023, more than half of Medicare recipients participate in Medicare Advantage. In addition, millions of Medicaid enrollees struggle with social determinants of health that make it harder to get the care they need. Both populations could benefit from more streamlined, targeted access to primary care.  

Existing risk stratification data from the Centers for Medicare & Medicaid Services (CMS) can identify specific patient groups within a payer’s current membership or geographic area that have specific needs. For example, this information can pinpoint older adults with congestive heart failure or patients with limited care access due to lack of transportation.  

An MSO can be a game-changer in these situations. By sharing risk stratification details, these organizations make it easier for payers and their providers to focus services and deliver high-quality care that accurately addresses patients’ needs. 

Outside of Medicare Advantage and Medicaid, MSOs can also boost provider engagement by: 

• Creating alternative payment models for groups 
• Proposing statewide contracts 
• Suggesting participation with an accountable care organization or other risk-bearing entity to fee-for-service or low-performing providers 
• Identifying providers who best align with a payer’s network 

Ultimately, Sheffield says, “MSOs help payers implement and support successful operations in a challenging and rapidly evolving health care environment.” They can have an enormous positive impact, ensuring payers implement well-structured, effective VBC strategies that help providers concentrate on patient care while simultaneously growing their business.