Clinical Integration

A PHO is a legal entity generally formed by physicians  and one or more hospitals with the intention of negotiating contracts with payers and sharing in the financial rewards of controlling costs while delivering high-quality care.

Clinical Integration-According to the FTC:

  • An active and ongoing program to evaluate and modify practice patterns by the network’s physician participants and create a high degree of interdependence and cooperation among the physicians to control costs and ensure quality.

This May Include:

  • Establishing mechanisms to monitor and control utilization of health care services that are designed to control costs and assure quality of care
  • Selectively choosing network physicians who are likely to further these efficiency objectives
  • The significant investment of capital, both monetary and human, in the necessary infrastructure and capability to realize the claimed efficiencies.