PHOs — Physician Hospital Organizations
A joint venture between a hospital (or health system) and its affiliated physicians, formed to negotiate contracts with health plans, coordinate care delivery, and manage shared financial risk. PHOs align hospital and physician incentives under a single contracting entity.
12
Primary Modules
6
Key API Integrations
6
Regulatory Requirements
Primary Portal Modules
Organization Providers Claims Financial Risk Pools Auth Analytics Care Coordination Billing Clinical Enrollment Population Health
Organizational Relationships
▲ Vertical — Reports To (Upward)
- Health plans/MCOs (contractual)
- Hospital board/health system leadership
- State regulators
▼ Vertical — Oversees (Downward)
- Affiliated physician practices
- Employed physicians
- Ancillary service lines
▶ Horizontal — Collaborates With (Peer)
- IPAs (may overlap physician membership)
- ACOs (often coexists with)
- MSOs (administrative support)
- Post-acute care facilities
- FQHCs (safety-net populations)
- Community health organizations
Key API Integrations
Hospital EHR/HIS (HL7 v2 ADT, FHIR)X12 837I/837P ClaimsQRDA Quality ReportingADT Event NotificationsX12 835 RemittanceCAQH ProView / NPPES
Regulatory Requirements
- State corporate practice of medicine laws
- Anti-trust compliance
- HIPAA across entities
- CMS Conditions of Participation
- Joint Commission accreditation
- Stark Law/AKS safe harbors