The passage of the Affordable Care Act has left many insurance and health care providers with administrative headaches as they work on bringing their facilities into compliance. Often they simply don't have the expertise to make the required changes. These providers turn to health care organizational experts like Managed Care Partners.
“Several elements of the health care reform legislation put pressure directly or indirectly on insurance companies and employers. This ultimately will translate into pressure on providers to reduce reimbursement,” said James Richmond, president of Managed Care Partners. “Our plan for the future is to continue to help clients survive in a world that is increasingly complex and unforgiving.”
As its name suggests, Richmond's company specializes in helping health care providers set up and run managed care systems. “We spend most of our time on activities related to being an outsourced managed care department,” Richmond said. “We have worked with over one hundred different managed care payers and administer over 750 contracts. Because we deal with payers and providers every day, the knowledge base of our team remains current.”
Managed Care Partners helps providers to assemble health care networks and guides hospitals in creating or acquiring physician groups. They also bring together health care providers and local employers to set up direct contracts. The introduction of Medicare Advantage plans in 1999 added a new complication to managed care, and Richmond works with providers to develop strategies for incorporating these plans.
Lately, Managed Care Partners has been helping clients plan for forming accountable care organizations, or ACOs. An ACO, as described by the Affordable Care Act, is a group of providers – primary care physicians, specialists, hospitals, and so on – that work together to offer a complete health care package. Each member of the network is jointly responsible for keeping their patients healthy. Because the providers in an ACO send patients back and forth within the group as needed and are equally liable for any problems, they must cooperate and share information seamlessly. ACOs won't come into effect until January 2012, but many provider groups are laying the groundwork in advance.
“When ready to move ahead, we will assist the ACOs to select vendors for backroom services, perform risk analyses, contract with payers and participating providers and manage the enterprise,” Richmond said. “We have also been very active in setting up programs that use the concepts of accountable care, patient-centered medical homes and population management to help provider clients improve the health and productivity of employees of area employers.”
Richmond is proud of the role that he and his partners have in helping health care providers succeed. “The four individuals who formed Managed Care Partners in 1994 all had many years of experience in the insurance industry and with managed care,” he said. “Many of our clients have been with us for more than a decade. We take pride in having helped them through the years with their managed care payer, employer, community and physician relationships.”
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