What Do PHM Companies Do?

I was reading a recent article in Fierce Healthcare about how an accountable care organization (ACO) has partnered with a population health management company to expand value-based care in rural Colorado, and it got me thinking: what is a population health management organization? And I don’t mean societies or trade organizations ‐‐ I mean companies that provide services to entities interested in shifting to a PHM footing. I’ve heard tell of such things, but never looked into it.

Until now.

As it turns out, there are a range of such companies that provide a plentitude of different population health services. Since they are too numerous to go into detail about here, I decided to focus on the PHM company spotlighted in the Fierce Healthcare piece, Collaborative Health Systems (CHS). And let me say right off the bat: I have no ties whatsoever to CHS and no experience working with them. Because of this, I can’t honestly say if they’re worth collaborating with or not. So this post shouldn’t be seen as an endorsement of any sort.

With that out of the way, let’s jump in. According to the article linked to above, CHS recently partnered with an ACO in Colorado called Community Care Alliance (CCA) to expand value-based care in rural parts of the state. The venture, called Collaborative Choice Healthcare, will aim to “reach rural health practices, critical access hospitals, and health systems throughout Colorado and eastern Utah…to improve quality outcomes and lower healthcare costs for Medicare beneficiaries.” 

The article notes that “CHS will provide CCA with data, strategic growth planning, care coordination and market leadership,” but it doesn’t go into much further detail except to note that the two entities will “enter value-based contracts with Medicare Advantage organizations,” and that CHS “helps payers align their goals more closely with health outcomes.”

This last part about value-based contracts and helping insurance entities align goals with health outcomes is interesting and may, in fact, be fodder for a future blog post. But for now I want to focus on what so‐called PHM companies like CHS do, and how they expand value‐based care to populations in need.

Before we go any further, it’s also important to note that CCA isn’t the only Colorado healthcare entity throwing its hat into the PHM ring. This article states that Montrose Regional Health, a healthcare facility servicing the San Juan Valley of Colorado, is joining the Collaborative Choice Healthcare venture. A source quoted in the article states that the technology needed to arrive at actionable insights “can often be cost-prohibitive for providers. Through this joint venture, Collaborative Choice Healthcare enables its provider partners to stand up their own technology, share data, and pull deeper clinical insights. More data allow providers to identify an emerging need before it becomes an emergency, which is a critical element of providing higher quality care at a lower cost.”     

On CHS’ LinkedIn page the Tampa, Florida‐based organization describes itself as “a management services organization that partners with primary care physicians as they move to value-based payment systems.” Founded in 2012 by a group of primary care providers, their website notes that as of 2021, “CHS managed two Next Generation Model ACOs, eight Medicare Shared Savings Program (MSSP) ACOs, and one Direct Contracting Entity with over 2,500 providers, mostly primary care physicians, covering nearly 130,000 Medicare beneficiaries.”

Aside from managing ACOs and other medical entities, CHS “partners with physician groups that have come together to form Independent Physician Associations (IPAs) and state-based primary care programs.” To help bridge their clients over to a value‐based care environment, they provide “administrative and management services such as care coordination and quality reporting, risk management and contracting, population health capabilities, and actionable data insights.” CHS works in conjunction with Centene Corporation Company, a large, multi-national managed care organization to provide these services.

As I stated earlier, although there are a number of companies starting to populate this space, CHS is pretty representative of others I’ve seen. I’ll keep watching this trend and highlight any innovations I come across in this area.

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