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The Growing Need for Population Health Service Organizations

By: Megan Reyna and Carla Stephens

What is it? A Population Health Service Organization (PHSO) offers a comprehensive suite of services designed to support providers and health systems transitioning to value-based care. These services include care coordination, ensuring accurate and complete documentation, and driving cost-effective high-quality health outcomes.

Why it matters: As the healthcare landscape continues to evolve, the shift from fee-for-service to value-based care is more pressing than ever. Providers and health systems will require strategic partnerships to successfully coordinate care, manage financial risks, and consistently deliver high-quality outcomes for their patient populations.

  • Adapting to Evolving Care Models: Providers and health systems are on an unstable trajectory if they remain overly dependent on a fee-for-service models and must embrace value-based care models to address the rising cost and reimbursement pressures exacerbated by the COVID-19 pandemic.
  • Navigating Financial Risk & Ensuring Sustainability: Providers and health systems are already at financial risk, whether through DRGs, TEAM (the new mandatory Medicare bundle model), or an unsustainable cost structure. Now is the time to adopt a diversified reimbursement model that not only ensures financial stability but also drives better health outcomes.
  • Realizing Longer-Term Benefits: Overtime, providers and health systems that mature in value-based care capabilities will recover initial investments and achieve steady financial performance.  By focusing on outcomes, rather than service volume, providers and health systems can engage their clinical teams and foster a culture of continuous improvement.

Key Partnership Selection Considerations

  • Proven Success in Value-Based Care Models: A partner with over a decade of experience in diverse value-based care models, including both payer and provider/health system models, can offer invaluable expertise in navigating complex risk and payment structures.
  • Advanced Technology & Analytics: To succeed in value-based care, it is crucial to leverage technology and analytics to segment populations and gain actionable insights. A PHSO partner with robust and adaptable analytics capabilities, coupled with innovative technology, can drive operational efficiency, reduce costs, and improve quality of care.
  • Local Market Support & Effective Cost Management: Healthcare is inherently local. A PHSO that provides tailored, market-driven support ensures successful problem-solving and optimized outcomes. This is vital for cost-effective care delivery under value-based models.
  • Comprehensive Service Suite & Capabilities: A successful transition to value-based care requires attention to patient attribution and engagement, accurate and complete documentation, and an evolving care model that focuses on delivering the right care at the right time and place. Additionally, strong physician and provider governance structures are critical for ensuring provider buy-in and achieving true transformation. A reliable PHSO partner will augment existing capabilities, not duplicate services, to ensure a seamless transition.
Health Select Services (HSS)

Health Select Services (HSS) is a comprehensive clinical and technical platform that empowers Accountable Care Organizations (ACOs) and health systems to thrive in value-based care. With more than a decade of proven success, HSS collaborates with healthcare leaders to innovate and address complex challenges while improving the accessibility, quality, productivity, and cost of healthcare delivery.

HSS is dedicated to supporting your ACO or health system in succeeding with value-based care. As more individuals are cared for through value-based programs, now is the time to invest in the necessary transformation to build a sustainable, patient-centered future.

Connect with us today to learn how HSS can drive meaningful change in your organization.

Meet the Authors

Megan Reyna, MSN, RN, ACRN serves as Chief Operating Officer of Population Health at Bon Secours Mercy Health & VP, of Population Health Operations at Health Select Services. In this role, she is responsible for the performance of our Accountable Care Organizations/Clinically Integrated Networks, recruiting participating primary care providers, and increasing new Medicare lives into our value-based programs. Reyna is an established clinical healthcare executive with over 18 years of experience in operations and value-based care.

Carla Stephens, MHA, CLSSGB serves as Population Health Client Management, of Population Health, at Bon Secours Mercy Health & Client Manager, of Population Health at Health Select Services. In this role, she is responsible for cultivating, designing, and scaling strategic planning efforts that create business growth on behalf of HSS. Stephens has 6 years of experience in healthcare operations.