Physician-Hospital Organization (PHO)
A comprehensive strategy to managing a myriad of risk-based delivery organizations
PHO: Unique Functionality for Managing Hospital-Based Organizations
The unique alignment between hospitals and physicians, commonly known as a PHO, creates a partnership to provide comprehensive, integrated, and coordinated healthcare at the optimal price point for both patients and providers.
Initiatives are normally enacted that span a range of settings and efforts, from multi-setting care coordination initiatives focused on a single condition to networks of caregivers accessing and exchanging a variety of clinical and financial information to deliver quality care.
We Provide an Integrated Focus in Managing
Division of Financial Responsibility
Population and revenue reconciliation
Automated claim administration and workflow
Embedded EDI functionality to facilitate data movement and sharing
Executive and department level dashboard and actionable oversight
Health plan audit management
Integrated evidence-based care guidelines
Care coordination/authorization processes
Flexible platform in managing risk and delegated responsibilities
Capitation/value-based profitability reporting
Why QuickCap for PHOs?
Operationally, many PHOs are viewed as a contracting vehicle for providers desiring access to health plan contracts that offer capitation and fee-for-service reimbursement methods, along with incentive opportunities. More advanced strategies align a full
value-based health care approach while managing global risk arrangements with a myriad of payor partners.
Today’s QC7 solution provides a sound basis toward managing shared or full-risk arrangements within the given PHO business structures. From basic fee-for-service payment methods through more complex global risk and value-based capitation structures as a Direct Contracting Entity (DCE) with CMS, QC’s configurable design is staged to meet PHO requirements today and toward the future. Regardless of the lines of business (LOBs) managed, QC7 is easily adaptable and ready to initiate new or improve current operational needs.
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The Health Information Trust (HITRUST) is a standards organization dedicated to security, privacy, and risk management. They developed the HITRUST Common Security Framework (CSF), which assists organizations in maintaining a comprehensive and secure approach to HIPAA compliance and managing risks. HITRUST is widely recognized as the benchmark in data security and privacy.
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The Health Care Administrators Association is the nation's largest nonprofit trade association for third-party administrators, stop loss insurance carriers, managing general underwriters, audit firms, medical managers, technology organizations, pharmacy benefit managers, brokers/agents, human resource managers, and health care consultants. HCAA has spearheaded the change of self-funding for more than 35 years.
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