Physician Health Plans (PHPs) are health maintenance organizations with a difference. While they are comprised of a network of healthcare professionals and deliver preventive, essential, and emergency care, the providers of a PHP maintain independent practices in their private office locations. PHPs are doctor-founded, doctor driven HMOs that value excellence of care more highly than a financial bottom line. Happily, however, as a partner in a PHP, a physician enjoys the benefits of an increased patient base and managed administrative services that work to increase the office's profitability.

A typical PHP serves residents in a specific geographic region, with available out-of-network care for members who need services while traveling. PHP providers include healthcare professionals in all disciplines, from family practice physicians to specialists. The majority of PHPs are administered by non-profit service organizations that take care of administrative tasks, freeing individual providers to focus on providing the best medical possible care.

What Makes a Good PHP?

The best PHPs in the U.S. not only offer a variety of membership options, from employer plans to individual coverage, but they also provide premium care at an affordable cost. The top PHPs also interact in positive ways to better the communities they serve. 

By creating a strong community infrastructure of comprehensive medical care within a geographic region, leading PHPs forge lasting bonds among medical professionals that translate into better healthcare for members. When PHP providers know they are referring patients to other providers they respect and trust, patients feel secure and well-cared for. This type of reassurance is often lacking in a large, for-profit HMO in which the sheer numbers of providers make it difficult to forge individual professional bonds.

While PHPs by definition are established by physicians, the best are those that enjoy ongoing governance by physicians who are members of the plan's board of directors. Having medical professionals on the board ensures that any organizational decisions take quality of care into account, with the primary emphasis on good medicine rather than profit margin.

Top PHPs: Capital District Physicians' Health Plan

Founded by physicians in New York State in 1984, Capital District PHP is an individual practice association based on a non-profit platform. CDPHP has a membership of more than 350,000 patients and a provider network that includes over 10,000 medical professionals across 24 counties. Eight individuals of the 15-member board of directors are physicians. 

CDPHP offers three business lines. Its basic CDPHP coverage extends to medicaid and medicare patients as well as care for families and children. Its Universal Benefits line is a preferred provider organization that includes high-deductible, exclusive coverage. The Capital District Physicians' Healthcare Network line administers member services and self-insured plans.

CDPHP has been recognized as one of the "Best Places to Work" by the New York State Society of Human Resources Mangagement in 2011. The National Committee for Quality Assurance conferred an "excellent" rating on CDPHP, and the New York State Health Accountability Foundation has tapped CDPHP as a top-rated regional health plan.

Capital District PHP is active in community outreach. It sponsors a Farmer's Market during the summer months in Albany, and offers members enrichment programs such as yoga and stress management classes.

Top PHPs: Physicians Health Plan of Mid-Michigan

PHPMM began as an offshoot of Sparrow Health System in 1980. The project of a group of forward-thinking physicians, PHPMM constituted the region's first independent practice association, a broad-based network of area physicians, medical centers, and healthcare professionals who provide a full spectrum of care. PHPMM currently includes over 1,300 practitioners and 11 regional hospitals in eight central Michigan counties. In fact, 98 percent of physicians practicing within PHPMM's coverage area are part of the health plan's network.

With a mission to improve member health status by providing high quality, accessible and cost-effective healthcare, PHPMM serves employer health programs, individual members, and government agencies such as Medicaid. Membership tops 70,000, with more than 400 employer programs.

In 2010, PHPMM was named the state of Michigan's best health plan for customer service by the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. The Michigan health plan has also consitently ranked in the nation's top health plans for customer satisfaction, and has been included in the top 100 American health plans selected by U.S. News & World Report.

Top PHPs: Physicians Health Plan of Northern Indiana

PHPNI, established in 1983, is a non-profit, physician-governed healthcare organization with a provider network of more than 2,000 medical professionals, including doctors, dentists, and medical centers. PHP Management Systems, Inc., is the organization's division that provides employer health plan services, including the development of customized health plans for mid- to large-sized businesses within the service region.

PHPNI is involved in the communities of Northern Indiana via sponsorship of programs such as Focus on Health and Super Shot free immunizations. Its yearly donations to Matthew 25, a health clinic that serves low income patients, help the uninsured and elderly get the care they need. PHPNI also sponsors Safety Village, an educational center for fire and police safety education for elementary-age children.

Physicians Health Plan of Northern Indiana has earned the A.M Best's rating, an internationally-recognized benchmark for evaluating an insurer's financial robustness. Its focus on excellent customer service has earned PHPNI a reputation for outstanding customer satisfaction in the communities it serves.

The Benefits of Becoming a PHP Provider

Physicians who value the ability to provide high quality, reasonably priced health care to their communities find that the PHP model integrates well with their professional priorities. Maintaining a private practice in an independent setting with the option to serve PHP members while retaining long-term, non-PHP patients gives physicians the freedom that traditional for-profit HMOs cannot provide. 

The PHP non-profit service organization administers the membership benefits, management, billing, and payments of the PHP patients, adding little administrative work to a physician's private practice while directing new patients to the provider. Joining a PHP is a wonderful way for a physician to network within the region with other professionals who value excellence of care.