Case Study: Developing a Clinically-Integrated PHO to Align an Employed Physician Network and Independent Community Physicians

Background A large multi-specialty physician group (wholly owned and operated by a four-hospital health system) took a 25-percent upside/downside risk as a percent of premium on 6,000 Medicare Advantage (MA) patients. After realizing losses of over $1 million the first year, they determined tighter alignment with key independent specialist groups was necessary to better manage […]

Developing a PHO: 6 Key Considerations

Payment and insurance reform have driven hospital/physician alignment over the past few years. With hospitals and physicians increasingly being held accountable for each other’s actions, the need for tighter integration has grown. The result: a spike in Physician-Hospital Organization (PHO) activity, with hospitals and health systems reviving PHOs that have languished since the ‘90s or […]
Virtual Visits Reimbursement

Preparing for Emerging Delivery Models: PHO Development to Facilitate Value-Based Care Delivery

Physician-Hospital Organizations (PHOs) are experiencing a resurgence, as hospitals and health systems grapple with ACOs, Bundled Payments, narrow networks and direct contracting in the wake of healthcare reform. During this informative, 45-minute webinar, HSG Partner David Miller and Director Travis Ansel will cover: The PHO model’s benefits under payment reform. How PHOs are being used […]

Re-Emergence of PHOs

Not everyone needs to become an Value-Based Care Organization (ACO) today. Some hospitals should consider developing a risk-friendly entity such as a Physician/Hospital Organization to address cost reduction targets for commercial insurers and large employers as a first step. These models typically pay for services at a discounted rate (e.g., Medicare levels) and provide bonuses […]