This relationship, expertise, and training make physicians an indispensable resource in the health care system and provides them a point-of-difference in the healthcare marketplace.
Physicians are exercising their market leverage through a variety of contracting and affiliation strategies which allow a group of physicians to speak with one voice. Such strategies also enhance physicians' access to the capital and management resources necessary to pursue cooperative business ventures such as managed care contracts and direct health care services contracts with employers. Purchasers of health care services are more likely to sign contracts with larger groups of physicians who can provide comprehensive services, within a specialty or in a specific geographic area, demonstrate high quality outcomes, assume risk, and provide unique, innovative, or collaborative health care services.
These services include comprehensive care of chronic medical conditions that benefit from collaboration among multiple entities such as specialty practices, imaging centers, home health agencies, and hospital systems working as a network.
Such networks have and will likely continue to develop with different presence in different markets. Those IPAs capable of controlling medical expense for large numbers of patients and assuming full risk capitation can exercise maximal control in the current environment.
Partial risk sharing, however, is more likely to be available to many IPAs. Optimally functioning IPAs can offer many potential benefits, including:. Physicians considering the development of, or participation in, an IPA should be aware of the potential risks. This is especially true when the IPA accepts significant risk for healthcare expenditures. These risks include:. Physicians contemplating the development of, or participation in, an IPA should consider the following guiding principles:.
Validate member eligibility and requirements for accurate medical services provision. Streamline online data movement for electronic data interchange EDI files, electronic health records EHRs , and other clinical documents. More articles for you Related Articles. Discover what tools TPAs need for smoother care coordination in healthcare through QuickCap, the leading workflow automation tool for healthcare payers. Reports audit the compliance preparations' performance and thoroughness, security policy, access controls for users, and risk management processes.
Blog Subscription Email:. Opt-In By checking, I agree to share my form responses. Than you! You have successfully subscribe to our blog updtes! Oops, there was an error sending your message. Please try again later. Technology and management strategies can help ACOs achieve cost optimization and revenue maximization.
ACOs make up 20 percent of Medicare beneficiaries, which emphasizes the urgency towards a more value-based healthcare system. Any accountable care organization can succeed as long as it overcomes these significant challenges. QuickCap 7 is a platform that can handle hundreds of surgery-based providers or manage a wide array of medical specialists fully adaptable to specific needs. The members of an independent practice association are not affiliated with any legal health organization prior to their grouping hence, they are independent.
These partnerships usually come with financial benefits like discounts for services from members. Independent practice associations are good options for physicians who do not want to give up their individual practices, yet who want to have some connection to an insurance network.
These associations can also be extremely convenient for patients, because patients in these networks typically do not need referrals to see any doctor in the association. Therefore, individual practice associations allow for a bit more freedom and fewer restrictions for physicians as well as patients. An IPA can also help doctors offload some administrative tasks and related costs for things like contracts, compliance and other practice management activities.
Joining an IPA gives providers access to better technology and even advice on how to run a profitable practice. This helps them reduce claims costs, as they can pay below-market rates for their insureds to receive medical treatment.
The world of insurance can be complicated. Subscribe to the Insuranceopedia newsletter and stay in the know! AMM then provides the staff, office space and computer systems necessary to verify physician credentials, inspect physician offices, pay claims, verify patient coverage and benefits, process referral requests to specialist, answer phone calls from patients and physicians, and monitor every patient that is admitted to any hospital.
AMM employs licensed nurses to work directly with the physicians in the IPA to coordinate the care of hospitalized patients; it employs professional administrators to oversee the HMO and provider contracts, regulatory compliance, and hospital relations; it employs computer programmers and engineers to develop and maintain technical software, computer networks and internet connectivity; it employs claims examiners, authorizations clerks, eligibility verifiers and customer service representatives to process the 40, claims, 10, referral requests and 10, telephone calls that are received by AMM each month on behalf of its IPA clients.
In addition, AMM employs general office staff, mail and file room personnel, human resources and management staff as well as maintains sophisticated computer file servers, internet servers, internal and external routers, workstations, telephone systems with automated call distribution, auto attendant and voice mail; mail processing equipment; and 18, square feet of prime office space.
0コメント