January, 2019

PURPOSE:

Community’s Provider Engagement Platform dictates that Community’s leadership incorporate feedback from Participating Physicians and Providers into Community’s operational decision-making. The Provider Engagement Council (PEC) is the primary forum in which Community accomplishes this endeavor. The PEC represents Participating Physicians and Providers from diverse specialties and practice settings. It serves as a sounding board for Community when considering various administrative, operational, or strategic initiatives. Collaboration achieved through the PEC;: (1) strengthens engagement from Participating Physicians and Providers, one of Community’s key stakeholders, (2) improves transparency in communication with Participating Physicians and Providers, and (3) fosters greater support from the Participating Physician and Provider community upon implementation of new initiatives.

RESPONSIBILITIES:

The PEC is responsible for providing input or guidance on various topics including, but not limited to:

  1. Policies and procedures impacting Participating Physician and Provider offices
  2. Initiatives related to Provider Engagement or Provider Incentives
  3. Suggestions on how Community might better engage with Participating Physicians and Providers
  4. Improvements to Member and/or Participating Physician and Provider satisfaction
  5. Improvements in performance by Participating Physicians and Providers as well as Community Health Choice
  6. Establishment of Quality and/or Utilization benchmarking standards 
  7. Opportunities to strengthen Member engagement

MEMBERS:

Participants in the Provider Engagement Council include the following:

Community Health Choice participants:

  1. CEO
  2. COO
  3. Chief Compliance & Quality Officer or designee
  4. SVP, of Medical Affairs
  5. Medical Director(s)
  6. VP, Provider & Network Operations
  7. VP, Sales & Member Operations or designee
  8. Director, Contracting
  9. Director, Provider Relations

Other Community staff may make special or periodic reports to the committee or may attend selected meetings ex-officio.

Physician and Provider participant guidelines:

Must maintain an active Participating Physician or Provider agreement

  1. Must maintain an active Participating Physician or Provider agreement
  2. Must be considered in good standing.
  3. Includes no less than twelve (12) or more than twenty-two (22) of the following participants representing the following provider types: 
    1. Primary Care Physicians (e.g. Internal Medicine, Family Practice, Pediatrics)
    2. High-volume Specialty Care Physicians
    3. Non-Physician Primary Care Providers (e.g. FQHCs, Advanced Nurse Practitioners, Mid-wives, etc.)
    4. Ancillary Providers (e.g. PT/OT/ST, Home Health, Laboratories, etc.)
    5. Facility Providers (e.g. Hospitals)
  1. Physicians and Providers with annual attendance of fewer than half of the scheduled meetings may be terminated from the PEC.
  2. Community will pay a stipend per meeting attended to Physician and Provider participants.
  3. Panel member terms will be limited to two (2) years initially, with an option to renew for a single one (1) year period.

 

MEETINGS:

The Council meets quarterly (4), but does not convene in the months of June or December, with the option to add additional meetings if needed.