Why Should I Join Northeast PHO?
The practice of medicine today is a complicated, sometimes confusing, ever-evolving system of insurances, provider networks and regulations. The Northeast Physician Hospital Organization (NEPHO) is here to help our providers make sense of it all so that they can focus on what matters: their patients and practice. The following is a list of just some of the services we offer to support our members:
- Negotiating commercial insurance contracts in order to obtain the best possible terms and reimbursement rates;
- Ensuring payments are received and distributed in timely and accurate manner;
- Handling initial health plan enrollment with all contracted payors, including the largest payors in Massachusetts: Blue Cross, Tufts Health Plan and Harvard Pilgrim Health Care;
- Processing patient insurance referrals from PCPs to Specialists in and out of our referral circle; and
- Producing reports with data that help drive decision making.
Most of the commercial insurance contracts negotiated by the Northeast PHO (NEPHO) and our affiliated organization, Lahey Clinical Performance Network (LCPN), have a provider incentive component which involves achieving certain standards of care in a number of quality measures relating to chronic conditions and preventive medicine. The Northeast PHO (NEPHO) has over 20 years of experience in this area and our staff is ready to help our providers and their care teams manage these populations with the following services:
- Our highly qualified and dedicated Nurse Care Managers work diligently to coordinate care and community services for patients after hospital discharge.
- Our Population Health Staff, consisting of a Nurse Practitioner and Health Coach, can provide patients with personal one-on-one assistance managing their diabetes or hypertension or scheduling their mammogram or colonoscopy.
- Our Pharmacy Management Team members seek opportunities for appropriate, cost effective prescribing and facilitate medication reconciliation with patients.
- Our Quality Team will provide data analysis, support and advice in an effort to help maximize performance in quality incentive measures.
These are just some of the benefits to becoming a member of the Northeast PHO. Our mission is to help our providers optimize their financial performance while providing their patients with quality care that is both effective and efficient. Please contact us today for more information on how you can join.