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Medicare+Choice PSO formation: a step-by-step decision process
1Jennings Ryan and Kolb, Atlanta, GA, USA.
Summary
Healthcare providers can now contract directly with Medicare via provider-sponsored organizations (PSOs) under Medicare + Choice. A methodical seven-step process guides providers through assessing, forming, and applying for these substantial opportunities.
Area of Science:
- Healthcare Management
- Health Policy
- Public Health
Background:
- Medicare + Choice program introduction creates new contracting avenues for healthcare providers.
- Provider-Sponsored Organizations (PSOs) enable direct contracting with Medicare.
- Significant time, resources, and risks are associated with establishing and managing PSOs.
Purpose of the Study:
- To outline a structured approach for healthcare providers.
- To guide providers in evaluating and pursuing Medicare + Choice PSO opportunities.
- To facilitate the process from initial assessment to contract application.
Main Methods:
- A systematic seven-step process is proposed.
- The process covers assessment, planning, and application phases.
- Methodology focuses on mitigating risks and optimizing resource allocation.
Main Results:
- A clear pathway is defined for providers interested in PSOs.
- The seven-step process provides a roadmap for successful PSO formation.
- Providers can navigate the complexities of Medicare + Choice contracting more effectively.
Conclusions:
- Healthcare providers should adopt a methodical approach to Medicare + Choice PSO opportunities.
- The proposed seven-step process offers a practical framework for engagement.
- Strategic planning is crucial for providers to leverage direct Medicare contracting effectively.