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Creating Accountability and Building PHO Revenues With Clinical Integration
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Creating Accountability and Building PHO Revenues With Clinical Integration

Client/Profile

PHO associated with a tertiary-care teaching hospital

Challenge/Situation

To help a successful PHO adjust to changes in regulations and market conditions by adopting clinical integration and expanding pay-for-performance.

Process

Veralon led strategic planning processes developing new strategies to replace the original contracting focus of the organization. The new strategies included an extensive clinical integration effort and significantly expanded pay-for-performance based on evidence-based clinical protocols and other quality initiatives. Veralon also assisted the PHO to enhance its disease-management program and develop an electronic medical record strategy. An information technology platform ties these efforts together, reducing fragmentation and increasing efficiency.

Results

The new strategies provide value to large payers in addition to the smaller payers that had previously been served by the PHO. This new client base significantly increased PHO revenue based on the true value of the services it was in a unique position to provide. The implementation of evidence-based protocols and pay-for-performance provided the foundation for this PHO to become an accountable care organization (ACO).