MSO

ACO

MSO vs. ACO

Model

Recurrent revenue model for physicians based on quality
of care with no risk to the physician. In this model the
physician has no financial risk and will not have to
pay any potential losses.

Payment

The physician gets paid a capitated amount
monthly plus a quarterly bonus based on quality
metrics. The physicians revenue is based on
performance and it is not dependent on the
other physicians in the MSO.

Contract

Contracted with the managed care company.

Time Tested

Has existed for over 20 years and is time tested.

Number of enrollees

Has no lower limit on Medicare enrollees.

Revenue

Provides substantially more revenue to the physician
(see EliteHealth YOUversity).

Model

Fee-for-service model with possible annul bonuses based
on shared savings on cost. In this model the physician is
at risk to possibly have to pay back potential losses.

Payment

The physician does not get any capitated or quar-
terly bonuses, but just a possible yearly bonus. It is
a risk model so the ACO could owe money back to
CMS. The physician’s payments are pooled and NOT
independent of the other physicians in the ACO.

Contract

Contracted directly with CMS.

Time Tested

New and no experience yet.

Number of enrollees

Needs a pooled base of 5000 Medicare members.

Revenue

Shares only 20% of the savings with the CMS. Therefore only 12% goes to
the ACO in the risk model. The ACO administration usually takes 50% so
potentially only 6% goes to the physicians pool.