- HealthONE Leading Hospitals Trusted Care
Denver, Colorado | Physician Hospital Organization | Rose Medical Group
Using the Messenger Model contracting methodology, Rose Medical Group provides access to seventeen group and/or individual contracts covering over forty product lines.
Federal Anti-Trust Law prohibits physicians that are not financially or clinically integrated from negotiating collectively; therefore, RMG functions as a designated “messenger” to represent each physician or physician practice individually. Each practice establishes its own unique minimum reimbursement requirements which are then conveyed to the health plans. Contract proposals are then communicated back to each practice and the practice makes an independent decision to accept or reject the contract offering. The process continues until an agreement is reached between the healthplan and the practice. The resulting contract(s) can be executed with Rose Medical Group as an organization or with the practices individually.
Successful execution of the Messenger Model process involves a significant level of physician education and communication. Physicians must be well educated on the Messenger Model process and actively participate in every contract by responding to all communications regarding contract proposals. With almost ten years experience in the execution and administration of the Messenger Model, Rose Medical Group will work closely with representatives from the different medical centers providing oversight on physician education and training of the proper and legal execution of the Messenger Model Process.
RIHN has over 275 primary care physicians in value based contracts. The physicians and payors/insurance companies expect any group of physicians in ACO and/or valued based contracts to have the appropriate infrastructure to administer such contracts. This includes payor contracting, nurse case management, medical directorship,financial oversight, distribution of funds, data analytics, and payor credentialing. RIHN has created this infrastructure and began deploying it in January of 2016.
Successful execution of ACO and Value Based Contracts involves working with the medical practices directly and sharing improvement methodologies and date to improve and maintain the cost and quality of care and bring higher reimbursement for those improvements. Our Value Based Contracts include Cigna, Anthem, Secure Horizons/AARP Medicare Advantage and Humana Medicare Advantage.
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