What is a Physician Health Plan (PHP)?

As a physician providing medical care in the highly competitive American healthcare environment, being a part of a network benefits your practice in a number of ways. 

Having standard office protocols in common with other area physicians can streamline patient intake and care while eliminating the dissatisfaction that often arises when patients’ expectations are not met. 

Utilizing a pricing structure that is standard in your medical community makes billing and receiving payment go more smoothly. In addition, membership to a physicians’ network with a management infrastructure gives your practice the stability of the group dynamic without the restraints of working for an HMO. 

What is a PHP? 

A typical Physician’s Health Plan (PHP) is comprised of an integrated network of medical professionals that join forces to provide high-quality, comprehensive patient care across the healthcare spectrum. Often, the founding physicians of a PHP establish a non-profit management service designed to oversee the record keeping, bookkeeping and coordination necessary to the network, leaving physicians free to focus on the practice of medicine. However, physicians do maintain positions on the board of directors, and the PHP remains an essentially physician-governed organization. 

A PHP includes primary care physicians and referral specialists who practice in their private offices within a statewide or regional area. Some of the larger PHPs interact with other similar organizations in different regions of the country to provide non-network benefits to members who are away from home or need specific services not available within their own PHP network. 

Physician Benefits of PHP Membership 

A successful PHP proves beneficial not only to physicians but improves the quality of patient care within the system by standardizing preventive procedures, same day, and emergency care. The management service oversees health plan billing and other general, non-medical procedures. It also strengthens the healthcare community by forging strong bonds between primary care physicians and the specialists to whom they refer patients. 

When you opt in to your local PHP, your current patients do not experience a gap in care, nor do they have to leave your office if they are not members of the PHP. Because each physician and other healthcare provider within a PHP retains the autonomy of a private practice, your existing patients can feel secure that simply because your office is joining forces with other PHP professionals, they will not experience a change in the high standards of care they have always enjoyed through your office. 

However, as a participating PHP office, your practice will enjoy a streamlining of time-consuming office procedures that can take time away from your primary mission – that of providing the best medical services possible. Additionally, your new PHP patients as well as your existing patient base will enjoy outstanding customer service. When PHP referral patients make appointments, they will know what to expect in terms of fee structure and quality of service, and as a result your customer satisfaction rating will soar. 

Another important benefit of joining your area PHP is broadening your patient base. Employers often select PHP healthcare coverage for employees because as a non-profit, physician governed plan, a PHP frequently offers the most cost-effective and comprehensive solution for employee healthcare. Additionally, the benefits of belonging to a regional physician’s network means that your office may be fielding referrals from other PHP member offices, just as you will feel confident referring your patients to network physicians and other healthcare professionals. 

If the thought of expansion and a new influx of patients seems daunting, due to your office staff limitations, remember that the organization structure of the PHP will provide many of those additional services required to keep your busy office running smoothly, and at a profit. The influx of PHP patients can even create additional jobs in your office. 

Case Study: CDPHP 

Regional physicians established Capital District Physicians Health Plan of New York in 1984 as a non-profit, individual practice healthcare association. After nearly 30 years in operation, CDPHP includes 350,000 patient members as well as a network of 10,000-plus healthcare providers and practitioners. CDPHP’s 15-member board of directors includes eight physicians. Membership is available through employee-sponsored, chamber-sponsored, government and individual plans. 

As is the case with most HMOs, whether they are physician-governed or otherwise, CDPHP provides many preventive care services as a benefit of membership. These include routine check-ups, pre-natal care, immunizations for children, and mammography. CDPHP adds free wellness programs to its preventive care roster, with such topics as nutrition and stress management as well as activities such as yoga. 

Community outreach is an important aspect of CDPHP program. One outreach project is the CDPHP Farmer’s Market in Albany NY, which operates from late May through early October. By participating with the community and utilizing the Farmer’s Market forum to promote health and nutrition, CDPHP solidifies good community relations. 

Capital District PHP was acknowledged by the New York State Society for Human Resources Management in 2011 as a top “Best Places to Work” in the state, offering excellent physician jobs and staff positions. It has earned an “excellent” accreditation from the National Committee for Quality Assurance, and has been named a top-rated health plan by the New York State Health Accountability Foundation. 

What PHP Excellence Means to Physicians 

The outstanding achievements of a physician-governed HMO such as CDPHP reflect well on its member physicians. Visibility within the community as a participant in valuable programs builds membership within the PHP, bringing additional patients to your office. Also, as a member of a well-managed organization that has established a trusted brand within the community, your office will enjoy improved customer satisfaction, which translates into a more positive work environment. 

A larger and better-served patient base is just one of the benefits of membership in a Physician Health Plan. Individual physicians can enjoy the benefits of membership in a PHP while retaining the autonomy of private practice, and well as offer additional physician jobs as the PHP practice expands. If you would like to work more closely with your healthcare community, look into your local PHP today!