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What is a “Clinically Integrated PHO”

  • A Physician-Hospital Organization (PHO) is a joint venture between physicians and a hospital/system that is authorized to contract with payers.
  • The FTC does not normally allow independent physicians, groups or hospitals to collectively bargain with health plans through a PHO or similar organizations like Independent Physician Associations (IPA). However, in order to encourage quality improvement, they have allowed providers to do so provided that they “clinically integrate.”
  • A clinically integrated PHO is a one that uses systems and processes to improve quality and reduce cost through evidence based medicine, performance measurement, information sharing, and alignment of incentives.

Quality Health Partners Was Developed to Capitalize On Long Term Market Trends As a Medical Community

  • The reimbursement system in place today rewards quantity not quality. QHP can help reward providers for delivering better care...and be reimbursed for the additional time and investment required.
  • Under any reform scenario, CMS will likely pay providers less for lower quality and it is in all of our interests to prepare.
  • If providers work together, they can pool investment, develop better technology and intellectual capital, and develop a more universal standard of care.
  • As healthcare trends seemingly force physicians to take sides and choose teams, this is an opportunity to work together on something mutually beneficial.

Benefits to Quality Health Partner Physicians

  • Improved efficiency through technology to share information, communicate with your colleagues, monitor your patient’s care, and improve quality and outcomes.
  • Opportunity to collectively negotiate better reimbursement and/or more rational incentives and share in the savings generated.
  • Prepare for the future of private and government payment changes.
  • Have a say in how care is delivered and measured rather than be told.

Key Elements of QHP

  • Contract Negotiation — Negotiate contracts with health plans on behalf of physicians and SIH. Fee-for-service payments continue to go directly to physicians and hospitals but using the new fee schedule.
  • Incentive Payments — Negotiate incentive funds from payers which will be distributed to physicians and hospitals based on performance on agreed upon metrics using a system designed by QHP.
  • Quality Improvement — Design and implement a set of clinical protocols and outcome measures which physicians will utilize to improve quality and outcomes.
  • Performance Measure — Implement an information system that allows QHP and its providers to measure clinical quality, outcomes at the PHO, group, physician and patient level.