The MSO vs ACO Model

The MSO vs ACO Model

Model :    MSO

 

Recurrent revenue model for physicians based on quality of care with no risk to the physician. In this model the physician has no financial risk and will not have to pay any potential losses.

 

Payment

 

The physician gets paid a capitated amount monthly plus a quarterly bonus based on quality

metrics. The physicians revenue is based on performance and it is not dependent on the

other physicians in the MSO.

 

Contract 

Contracted with the managed care company. 

Time Tested 

Has existed for over 20 years and is time tested.

 

Number of enrollees

 Has no lower limit on Medicare enrollees.

 

Revenue

 

Provides substantially more revenue to the physician

 

 

 

Model :  ACO

 

Fee-for-service model with possible annual  bonuses based on shared savings on cost. In this model the physician is at risk to possibly have to pay back potential losses. 

Payment 

The physician does not get any capitated or quarterly bonuses, but just a possible yearly bonus. It is a risk model so the ACO could owe money back to CMS. The physician’s payments are pooled and NOT independent of the other physicians in the ACO.

 

Contract

Contracted directly with CMS. 

Time Tested 

New and no experience yet.

 

Number of enrollees

Needs a pooled base of 5000 Medicare members. 

Revenue 

Shares only 20% of the savings with the CMS. Therefore only 12% goes to

the ACO in the risk model. The ACO administration usually takes 50% so

potentially only 6% goes to the physicians pool.

 

 

For More Details : 305-227-2383   or 1-877-938-9311

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

HPP Management Group, Corp

5201 Blue Lagoon Dr.

Suite 815

Miami, FL 33126

Accountable Care Organizations (ACO) - General Info

ACO

Definition:

 

What's an ACO? 

Accountable Care Organizations (ACOs) are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to their Medicare patients. 

The goal of coordinated care is to ensure that patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors. 

When an ACO succeeds both in delivering high-quality care and spending health care dollars more wisely, it will share in the savings it achieves for the Medicare program. 

 

New models encouraging coordinated care?

 

The CMS Innovation Center offers a menu of alternative options, including:

•Comprehensive Primary Care initiative

•Bundled Payments for Care Improvement initiative

•Community Based care Transition Program

 

ACO do have Quality Measures in place [ 33 ACO Measures for PY2015 ]

 

For more information on ACO , please contact us at  :

 

305-227-2383   or  1-877-938-9311

 

To contact us by email :   fcortes@hppcorp.com     or   psilben@hppcorp.com