MSOs, administrative services organizations (ASOs), care management organizations (CMOs), population health services organizations (PHSOs) and the functions they provide, come in many shapes and sizes. The governance, structure and functionality of a MSO is unique to the health system, IPA, ACO or health plan it is designed to serve. A provider taking risk can design or outsource an MSO for a single function/service or many functions/services depending on their needs. Many health systems are balancing the MSO type needs of a wholly owned or joint venture health plan, one or more ACOs and one or more IPAs. As a result, health systems and provider organizations across the country are grappling with decisions about which functions they can realistically provide and how they can organize themselves to deliver these functions in a cost-effective way that allows them to capture and effectively manage as much of the premium dollar as possible.
COPE Health Solutions helps health systems and vendors consider the significant investments that administrative and operational functions represent for health systems and other provider organizations. We help in assessing how major investments in MSO services need to align with other major IT and systems investments such as electronic medical records (EMR), referral platforms, health information exchanges (HIEs), etc.