What is Saint Anthony PHO?
Saint Anthony Physician Hospital Organization (PHO) is made up of primary care physicians, specialists, and Saint Anthony Hospital. Together, we thrive in providing quality healthcare to members of our community, focus on preventive healthcare, and build strong physician-member relationships that will continue to improve healthcare outcomes for the members we serve.
Saint Anthony PHO is also a contracting vehicle for providers who wish to have access to health plan contracts that offer capitation and fee-for-service reimbursements, along with incentive opportunities. These may include HMOs, PPOs, and Point of Service (POS) plans.
How does Saint Anthony PHO work?
Our role is to simplify and clarify your ability to participate in multiple health plans through a single contracting entity. You will also have the opportunity to designate which health plan contracts you and/or your practice wishes to participate in. You, the physician and/or group, will bill and be paid directly by either Saint Anthony PHO or by the health plans for your services.
Who is eligible to join?
Any physician in good standing with active medical staff privileges at Saint Anthony Hospital or SAH Community Care Clinics and who has an active Medicaid and Medicare provider ID number.
Physician Benefits and Flexibility
By becoming a participating provider with Saint Anthony PHO, you have access to multiple contracts through one contracting entity. In addition, physicians can selectively participate (opt in/opt out) in PHO health plan contracts.
Many of the PHO contracts financially reward physicians for providing quality healthcare services. These financial rewards are paid directly back to the physicians, enhancing their revenue.
Saint Anthony PHO will conduct contractual discussions on behalf of the PHO provider network and present the best available offer to physicians for their decision. As Saint Anthony PHO adds new contracts, physicians will have the opportunity to participate in additional plans that they may not have had access to in the past.
Saint Anthony PHO Leadership
Tabitha Watts, M.D. - President & Assistant Medical Director
Tyla Courtney, M.D. - Vice President
Ogbonnaya Aneziokoro, M.D. - Medical Director
Mohamed Dahodwala, M.D. - PHO Member
Christine Raguso - Executive, PHO Member
Affiliated Health Plans
- Aetna Better Health
- Be Well Partners in Health
- Community Care Alliance of Illinois
- CorVel Coporation
- Galaxy Health Network
- Healthcare's Finest Network (HFN)
- Land of Lincoln Health
- Next Level Health
- Unite Here Health
How will Saint Anthony PHO work for new contracts?
Saint Anthony PHO will work with Managed Care Organizations (MCO) and independent health plans to obtain the best offer, for both financial and non-financial terms. The Saint Anthony PHO will then communicate the terms of the contract to physicians who will individually decide to accept or not accept the contract by signing and returning the Payor Notice.
What kind of plans will Saint Anthony PHO participate in?
Saint Anthony PHO will contract with capitated (risk) and fee-for-service (non-risk) plans, regardless of product type. These may include traditional plans such as HMOs, PPOs, and Point of Service (POS) plans.
Can an individual physician choose which plans to participate in? Must the physician accept all, or is it possible to participate in some and not others?
Saint Anthony PHO is specifically intended to allow physicians an opportunity to decide, on an individual basis, which contracts he/she will participate in. However, physicians that agree to participate in any risk agreements must participate in all of the PHO's risk contracts. This provides the PHO and its providers an opportunity to effectively manage its costs, reduce utilization, and engage providers in decision making, including bonus sharing opportunities. It also provides our members with a full network of providers that will provide dedicated, quality care in a cost-effective manner.
Saint Anthony PHO does allow each physician the opportunity to decide, on an individual basis, which non-risk health plan he/she wishes to participate in.
Will Saint Anthony PHO negotiate fee schedules on behalf of the group? Will Saint Anthony PHO accept multiple payment models, such as RBRVS, fixed fee schedules, and others?
The methodology of payment (e.g., RBRVS, proprietary fees schedule, discount, etc.) varies by MCO and Health Plan. Saint Anthony PHO will not necessarily advocate for a specific or preferred model but will obtain the best terms available from the MCO/Health Plan and communicate that to physicians for their individual participation decisions.
What is the advantage of participating with Saint Anthony PHO?
The primary advantage for a physician practice is simplified contracting; however, with new federal and state initiatives many providers are seeking to participate in joint ventures that will better prepare them for the future of healthcare. In addition, Saint Anthony PHO will conduct contractual discussions on behalf of the PHO provider network and then present the best available offer to physicians for their decisions.
Saint Anthony PHO strives to be not only an organization that provides quality care for its members; it also strives to be financially profitable. Financial stability comes with proper management of healthcare services and healthcare dollars. These profits are disbursed to the PHO partners using a measured metric system that focuses on quality and utilization. Incentives are paid out annually.
Is there a current directory of providers participating in the PHO?
Yes. Here is the current PHO Physician Directory (PDF: 4 pages | 400 KB).
Who do I contact for more information?
Please contact the Saint Anthony PHO at 773.484.4833.