WHAT IS A PHO?
A Physician Hospital Organization (PHO) is a formal partnership between one or more hospitals and a network of physicians. Its primary purpose is to negotiate managed care contracts collectively, improve care coordination, and integrate services between hospitals and physicians. PHOs are designed to streamline administrative processes, enhance bargaining power with payers (like insurance companies), and promote quality improvement initiatives.
KEY FEATURES OF A PHO
STRUCTURE:
Typically includes a hospital
(or hospital system) and
affiliated physicians who join under a single legal entity.
PURPOSE:
- Negotiate contracts with health insurers or managed care organizations.
- Improve patient care coordination and efficiency.
- Share resources like electronic health records (EHRs) or quality improvement programs.
BENEFITS:
- Stronger collective bargaining power.
- Better integration of inpatient and outpatient care.
- Shared risk and reward models for cost control and quality outcomes.
LIMITATIONS:
- Potential conflicts between hospital priorities and physician autonomy.
- Requires robust governance and clear financial arrangements
KEY FEATURES OF A PHO
STRUCTURE:
Typically includes a hospital
(or hospital system) and
affiliated physicians who join under a single legal entity.
PURPOSE:
• Negotiate contracts with
health insurers or managed care organizations.
• Improve patient care
coordination and efficiency.
• Share resources like electronic
health records (EHRs) or quality improvement programs.
BENEFITS:
• Stronger collective
bargaining power.
• Better integration of inpatient
and outpatient care.
• Shared risk and reward
models for cost control and
quality outcomes.
LIMITATIONS:
• Potential conflicts between
hospital priorities and
physician autonomy.
• Requires robust governance
and clear financial
arrangements
ADVANTAGES OF A PHO
Provides a clear, organized way for hospitals and physicians to manage population health and coordinate care more effectively across the entire care continuum.
Acts as a central hub for administrative tasks—like insurance credentialing and utilization management — reducing the paperwork and workload for individual providers and facilities.
Promotes high-quality, cost-effective care by encouraging evidence-based standards, offering decision-support tools, and cutting down on unnecessary variation and overuse of services.
Aligns financial incentives for participating physicians, helping them improve cost, quality, and efficiency in step with evolving reimbursement models.