Mercy PHO Participation Has Its Advantages

s CREDENTIALING s CONTRACT NEGOTIATIONS s
s MESSENGER MODEL s COMMUNICATION s AMERINET s

CREDENTIALING- Mercy Health System PHO meets or exceeds National Committee for Quality Assurance (NCQA) and other regulatory agency standards when credentialing and recredentialing PHO participant applicants. Participants are credentialed upon initial application and triennially thereafter. The PHO's Board of Trustees has established a Credential's Committee to oversee the process and make recommendations to the Board for the final approval. Credentialing means the process of verification that the physician or practitioner is adequately trained, licensed, licensed in the jurisdiction in which the physician or practitioner maintains his/her practice, of good professional reputation, capable of working with others to provide health care services to covered persons, and in conformity with PHO Performance Standards for clinical quality, resource utilization and cost effectiveness. Mercy Health System PHO is delegated to complete this function on your behalf for 26 PHO payors. Thus, the labor-intensive process of submitting credentialing information is limited to one submission…the PHO, we take care of the rest!

CONTRACT NEGOTIATIONS- The outcome of a successful negotiation improves (to the benefit of all parties involved) the terms of an agreement or relationship. Presenting a panel of nearly 600 physicians and three hospitals to any payor serves as a catalyst for acquiring contractual language not afforded to a practitioner seeking a direct contract. Consequently, PHO physician participants save time and expense negotiating, and obtain better contract language. The PHO uses managed care and legal experts who review all contracts, ensuring that the PHO and its Participants are well represented and protected. For non-risk contracts, the financial terms are not negotiated by the PHO due to antitrust considerations. Instead, each physician or practitioner makes an individual decision about the financial terms offered by the payor. The PHO's physician and hospital representatives review and approve contracts before they are executed, through the PHO managed care committee, with final approval by the PHO Board Of Trustees.

MESSENGER MODEL- Payor participation made easy; you decide whether or not to participate. As the PHO successfully secures new payors, physician or practitioner participants receive an overview of the product, including the fee schedule. Your signature on the execution page initiates the enrollment process. The PHO will also act as the communication liaison for any changes in your practice status, e.g., demographic, tax ID, etc.

COMMUNICATION- Several methods of communication are used to keep participants apprised of current activities and upcoming events. The Monday Morning News is published monthly and provides a brief update on current activities. The PHO Update is distributed when time important information must reach the PHO participants quickly. The PHO also provides educational sessions when distributed information requires further explanation and input. Quarterly, PHO Physician Office Managers gather to learn about topics they have previously identified as areas of interest, and to exchange best practice options.

AMERINET- As a PHO participant, you have access to AmeriNet, the nation's largest membership-based health care group purchasing organization. AmeriNet is considered one of the most progressive health care industry group purchasing and shared services organizations in the country. AmeriNet offers participants substantial cost savings on supplies and access to a variety of innovative products and services. Beyond the traditional role of a group purchasing organization, AmeriNet has developed innovative cost saving and quality enhancing programs such as administrative services, offering over 100 consulting contracts with nationally recognized health care service firms. AmeriNet operates a regional education service, dedicated to providing educational programs, which are customer driven, competitively priced, and convenient.