The IPA-MSO: An Evolving Model
Over the last two decades, we have seen many Independent Provider Associations (IPAs) come into existence and then disappear. We have recently seen how JSA floundered, having bitten off more than it could chew. More and more, it seems to me that an IPA without the required infrastructure and operational bandwidth is at a high risk of failure. That is an IPA has to become more than just a coming together of sundry providers. It has to provide services, products, platforms and resources to its providers, and possibly, to other providers as well.
Thus, an IPA has to become a Management Service Organization (MSO) too. That is, it is to perform functions which enhance the efficiency and productivity of its constituent and affiliated practices. We believe that these services would include, though they certainly would not be restricted to, these vital functions:
1) Credentialing and contracting including delegated services from health plans
2) Care management, including utilization management, disease management and case management which may be delegated from health plans
3) Claims platform to assist with capturing risk-adjustment scores and getting data real time for gap analytics
4) Compliance, including auditing services, and billing and coding
5) Educational services, including certifications and continuing medical education for providers and staff
6) Quality to improve STAR ratings including HEDIS
7) Care coordination centers to enhance engagement and outcomes
8) Reporting and analytics, including daily census in hospitals and skilled nursing facilities
9) Claims reports and portals
10) Marketing, including traditional and digital and social medal management
These are a few that come to our mind right away. Contrast this with a few years ago, when our IPA was not expected to do any of these functions. Our goal this year is to consolidate and enhance these services and offer them across the board to all our providers as a value enhancement. It is also our aspiration to reach 5 STARS on all health plans, achieve 95 % scores on all our compliance testing, auditing and reviews and achieve zero-error care management system that also includes recoveries of fraudulent claims that have been paid. We believe these will empower our providers to be more successful in patient care and professional success.