Understanding MCOS:
Texas is now an MCO world,
and we're all just living in it.
by Cole Ballweg

 
 

Original published January 2, 2017

If you operate a pediatric nursing or therapy company you know that some things have not been as bad as your worst fears, while other challenges are beyond your wildest dreams. So where is this headed? What can you do?

We recently created an eBook (that you can get here) that offers 4 things you can do to navigate this new system effectively. Will it guarantee success? You're precious. No, there are no silver bullets, but we can all use some direction when things seem out of control. As leaders of organizations we are expected to have answers and be confident, so I invite you take in anything that gives you more of each.

Generally speaking, I think there are some silver linings in the changes if you can squint your eyes and see them. Some MCOs have been pretty pleasant to work with , and fairly to quick to recognize that they are learning how to work with the special needs population. For providers who knew how to bill correctly (or had a partner who guided them, wink), invoices have been paid much sooner than anticipated. And while we await possible utilization cuts in the future, new clients have been approved without much of a fight. All in all, it could be worse.

Of course with therapy rate cuts taking effect and PDN hours anxiously awaiting the end of the 6-month grace period, things could definitely get bad. It is a good time to review your systems to make sure everything and everyone are running as efficiently as possible before revenue and margins get squeezed.

In a few months we will have more critical data on how MCOs are handling rate issues, payments, and utilization. We at CubHub will be staying on top of it so we can be better partners to our clients. If you aren't a CubHub user I hope you are talking with your competitors about what is happening out there, because there is simply too much going on to be on an island.

Best of luck to you, brave souls. This is the business we have chosen, and for those who stay ahead of the curve I see a ton of opportunity. For those who have their heads buried in the sand, well...


Cole Ballweg is the President of CubHub. He has been operating pediatric homecare businesses since 2000, and designed CubHub to give companies the tools they need to grow while providing better patient outcomes.