Podiatry > Role of the Podiatry Professional Advisory Committee
EmblemHealth works with participating specialists to ensure the fairness and integrity of the Market Share Payment program. To provide an appropriate forum for practitioner input, we have established the Podiatry Professional Advisory Committee (PAC), a panel composed of professional EmblemHealth staff members, as well as peers from the New York podiatric community. The PAC supports the EmblemHealth Quality Improvement Department and Medical Director. The PAC's responsibilities include:
- Reviewing the clinical results of the program
- Recommending process improvement initiatives
- Providing unbiased explanation of program to peers
- Encouraging dialogue between EmblemHealth and practitioners
- Facilitating practitioner education
- Establishing appropriate community standards of care
- Creating a functioning peer review process
- Encouraging and helping the development of clinical quality indicators
- Monitoring specialty-specific quality metrics
- Reviewing specific cases to determine if they meet exceptional case criteria
Glossary terms found on this page:
An organization comprised of individual physicians or physicians in group practices that contracts with the managed care organization on behalf of its member physicians to provide health care services. Also called an Independent Practice Association.
Acronym for Medicare Advantage. An alternative to the traditional Medicare program in which private plans run by health insurance companies provide health care benefits that eligible beneficiaries would otherwise receive directly from the Medicare program.
A doctor of medicine or doctor of osteopathic medicine who is duly licensed to practice medicine and is an employee of, or party to a contract with, a utilization management organization, and has responsibility for clinical oversight of the utilization management organization's utilization management, credentialing, quality management and other clinical functions.
An individual and each of his or her eligible dependents, including Medicare beneficiaries who are enrolled or participate in a benefit program and who are entitled to receive covered services from the practitioner pursuant to such benefit program and the terms of the practitioner's agreement.
A type of health benefit plan that allows enrollees to go outside the health plan's provider network for care, but requires enrollees to pay higher out-of-pocket fees when they do. Also called Point of Service.
A health plan that offers benefits in-network and out-of-network. In-network services are available to enrollees at lower out-of-pocket cost than the services of non-network providers. In addition, PPO enrollees may self-refer to any network provider at any time. Also called a Preferred Provider Organization.
The process to objectively and systematically monitor and evaluate the quality, timeliness and appropriateness of covered services, including both clinical and administrative functions, to pursue opportunities to improve health care and resolve identified problems in any of these services.