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Services

South Shore PHO provides the following services for our members:

  • We enter into managed care insurance contracts on behalf of our member providers.  Under such contracts, South Shore PHO member providers agree to deliver certain health care services to their managed-care patients for a contracted payment amount.  Such arrangements are called “risk-based” contracts because some or all of a health provider’s payments from an insurer are at risk if certain patient care quality and utilization targets are not met.  It is expected that the majority of patient care will be delivered by and among those who are South Shore PHO members because they share a commitment to achieve the same quality and cost containment goals for their patients.

  • We administer managed care and other health insurance contracts.  South Shore PHO helps our member providers successfully administer risk-based and other health insurance contracts.  Services include data warehouse access and interoperable electronic information exchange among our member providers. 
  • We analyze contract performance.  South Shore PHO helps our member providers successfully administer risk-based insurance contracts by measuring, analyzing and reporting the extent to which performance standards are being met. We regularly report utilization and medical expense information that is used to identify how to improve the patient experience and lower costs.

  • We provide medical management services.  South Shore PHO works with our member providers to develop and implement pathways to better coordinate patient care, increase the appropriate use of lower-cost interventions, encourage the use of community-based care, and utilize disease-management protocols for patients with chronic health conditions.  Our nurses assists member providers and their office staff in collecting, reviewing and acting on quality data.  We also make calls and send reminder letters to patients about the importance of scheduling recommended health screenings.

  • We offer educational programs.  South Shore PHO provides opportunities for our member providers to remain abreast of emerging risk issues related to health care reform, as well as traditional risks such as malpractice claims, workers’ compensation costs, and many other diverse liabilities.

 

 © 2017 South Shore Physician Hospital Organization
1221 Main Street Suite 202, South Weymouth, MA 02190
Phone: 781-624-4200   Fax: 781-624-4221