July 1, 2015

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 Provider Engagement Council, under the authority of its Charter, 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. Implementation or revision to Community’s Provider Engagement Platform
  8. Opportunities to strengthen Member engagement

MEMBERS:

Participants in the Provider Engagement Council include the following:

Community Health Choice participants:
  1. VP, Network Management
  2. SVP, of Medical Affairs
  3. Medical Directors
  4. VP, Quality
  5. Director, Contracting
  6. Director, Provider Services
  7. Director(s), Member Services,
  8. Director, Claims
  9. Director, CM/DM
  10. Director, UM
Physician and Provider participant guidelines:

 

  1. Must maintain an active Participating Physician or Provider agreement
  2. Must remain above the 75th percentile in any currently measured quality metrics
  3. Includes no less than twelve (12) or more than twenty-two (22) of the following participants:
    1. Participating Physicians or Providers 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)
    • Other Community staff may make special or periodic reports to the committee or may attend selected meetings ex-officio.)
    • Members with annual attendance of fewer than half of the scheduled meetings may be considered for termination from the PEC.)
    • Community will pay a stipend per meeting attended to Physician and Provider participants.)
    • Panel member terms will be limited to three (3) years initially, with an option to renew for a single three (3) 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.

The VP, Network Management serves as Chair, and the Director, Provider Services serves as chair in the absence of the VP, Network Management.

PARTICIPATION PROTOCOL:

  • Identify a Facilitator, Timekeeper, and Note Taker for each meeting
  • Notify meeting Facilitator in advance if you will be absent
  • Agenda will be sent prior to meeting by the Facilitator
  • Note Taker will distribute minutes from the previous meeting within 4 business days
  • All members are expected to be physically present in attendance during meetings.
  • Exceptions may be made for teleconferencing in special circumstances, at the decision of the committee Chairman

PERFORMANCE EVALUATION:

Each year, the PEC shall review and assess the adequacy and appropriateness of this Charter as well as the PEC’s performance.

AMENDMENTS:

Amendments to this Charter require approval by the Executive Quality and Compliance Committee (EQCC) following recommendation by the Medical Affairs / Network Management (MA/NM) Leadership Team.

REPORTING RELATIONSHIP:

Reports directly to the Executive Quality and Compliance Committee (EQCC).