CIN/IPA MSO Co-Source

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Background

Our MSO Co-Source client is a provider-led health system, physician governed clinically integrated network (CIN), and independent physician association (IPA) in the Northeast. The IPA is committed to enabling network providers to successfully perform in value-based payment (VBP) contracts with payers through strategic collaboration, powerful data & analytics, enhanced provider engagement strategies and population health programs improving quality performance, total cost of care, and revenue optimization. The IPA’s network extends across eight counties of Western New York.

 

Challenge

The IPA faced a key turning point as new competitors had entered the market when CMS and payers became more aggressive and engaged around moving providers into VBP arrangements. Our client needed to quickly understand its population health management and VBP gaps to be successful in a transition to full risk for all lines of business. COPE Health Solutions (CHS) engaged an initial gap assessment and then launched an “MSO co-source” engagement that supports the IPA in achieving growth, increasing premium access through VBP arrangements, and improving performance under those arrangements.

 

Approach

CHS began by conducting a rapid gap assessment of MSO capabilities while ensuring client alignment on VBP goals and objectives. Alignment among the IPA’s two health system owners, and the physician leaders across the IPA network on VBP contracting and network growth goals was key to the development of a detailed VBP roadmap and timeline containing key milestones needed to ensure readiness for success in full risk VBP agreements over an initial three-year build and growth period. As part of this process, a three-year financial pro forma and detailed VBP contracting playbook were developed to inform decision making around investments, expected ROI for the IPA and health plan negotiations around VBP arrangements.

 

Outcomes

In the first 9 months after MSO Co-source launch, the IPA has:

  • Created a clear and competitive IPA value proposition that enabled IPA to contract new community physician groups and grow membership by 30,000+, a 20% increase in growth going into 2023
  • Aligned the two owner health systems and contracted IPA physicians around a common strategy, goal and objectives for VBP contracting, network growth and performance
  • Launched all aspects of the MSO co-source, providing interim management and supporting recruitment, and on-boarding of a new IPA management team
  • Initiated an integrated operating model for care management/care model, clinical guidelines, pathways, workflows, IT/analytics and network engagement and growth across health systems, IPA and contracted physician operating teams
  • Introduced Transitions of Care Program
  • Completed and successfully submitted the ACO REACH application and received provisional approval of ACO REACH entity (47% applicants selected nationally)
  • Entered into negotiations with two major payers to transition from early stage VBP agreements to full risk arrangements in 2023 or 2024
  • Enhanced provider engagement outreach and performance reports to entire network

 

To learn more about how we can help you build or accelerate success for your IPA, CIN or ACO please contact
info@copehealthsolutions.com or call 213-259-0245.

 

 


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