Gwen RobertsThere have been numerous seismic shifts in the healthcare industry lately – almost too many to keep up with, let alone take advantage of. Sometimes we need a bit of help from trained experts and professionals.
Healthcare transformation assistance is a vital service in today’s medical industry, and will become increasingly more so as the industry struggles to make sense of changes in insurance providers; the Affordable Care Act; the proliferation of Urgent Care; and many other areas.

We talked to Gwen Roberts of BHM Healthcare Solutions to ask some advice on healthcare transformation assistance – what it is, what it accomplishes, and how to reap the rewards.

Can you briefly describe what healthcare transformation assistance is and why it’s important?

Healthcare transformation assistance spans a wide array of services. Organizations looking to form an MCO or an ACO or providers looking to build their service offerings through mergers will benefit from our services.
Why is this important? For survival, revenue growth and success to maintain currency in the dynamic world of healthcare.

In the section about Healthcare Transformation Assistance on your website, you talk about Accountable Care Organizations and Managed Care Organizations.  What are ACOs and MCOs? How are they alike, and how are they different?

An Accountable Care Organization, or ACO, offers integrated care for its members, assumes risk-sharing arrangements with their payers, and strives to reduce the cost of care while maintaining and improving member outcomes. Members can choose to join an ACO; whereas a Managed Care Organization, or MCO, typically requires members to participate (most especially with Medicare and Medicaid participants).
Another difference is the assignment of a primary care physician which is common in an MCO setting; however, an ACO member has the freedom to select services from the panel of practitioners who are a part of the ACO. Both organizations share quality member outcome goals as well. Most recently, MCO have been focusing on integrated care models.

What are some reasons why it’s a good idea for physician groups to move towards being a Managed Care Organization?

Forming an MCO gives physician groups an opportunity for an expanded member base, thereby improving their revenue streams and keeping them relevant in today’s market. Single office practitioners will find it more and more difficult to be successful during this evolution.

Patient Centered Medical Homes are becoming increasingly commonplace because they empower patients as informed consumers. What effects do you predict PCMHs will have on the medical industry as they continue to rise in popularity?

Healthcare becomes more of a commodity as PCMHs grow. Consumers will demand better services for their dollar and will not tolerate mediocre results. They will have the power in their hands.

Along those lines, what are some reasons a practice should consider getting PCMH and NCQA certification?

Certification or accreditation is earned through a series of tough evaluations and maintenance of high standards. These certifications affect culture changes in organizations that are beneficial to not only the accreditation certified body, but to the members using or purchasing their services.

This white paper from talks about some reasons why healthcare reformation is mandatory, the most notable being the Affordable Care Act. What impact will the ACA have on practices, and why might they need some assistance in transitioning?

The impact of the ACA strikes at the foundation of most practices in the areas of revenue management and patient outcomes. Practitioners are historically not the best financial analysts, and the ACA brings with it many payment options that will not be familiar to office managers, as well as unleashing pent-up medical demands as more of the population is able to seek treatment.
Our assistance focuses on these new areas of opportunities and helps position practices for success rather than being overtaken by these issues.

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Last Updated on May 27, 2021