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Setting Direction in Clinical Integration for a PHO
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Setting Direction in Clinical Integration for a PHO

Client/Profile

PHO interested in building clinical integration capabilities

Challenge/Situation

To assist the PHO in deciding whether and how to pursue a clinical integration strategy. This included assessing the PHO’s readiness for clinical integration and its fit with their strategic goals.

Process

Veralon facilitated a planning process, starting with a detailed internal and external assessment of current and potential pay-for-performance and risk sharing contracts, the PHO’s current resources, and the resources that the transition to clinical integration would require.

Results

We found that the PHO needed to engage specialist physicians, and recommendations were made for inclusion of specialists in various leadership committees and roles. We also recommended that the PHO transition to a medical management model in which they controlled design and implementation, rather than their current payer-driven model, which is designed and implemented by the payers. Finally, Veralon delivered a detailed timeline specifying key initiatives that the PHO should implement as part of their clinical integration strategy.