Network Selection Criteria

Select Care Network

Physicians

The Select Network includes a full range of primary care physicians and specialists. It is designed based on specific criteria that are applied to select participating primary care physicians and specialists. For primary care physicians we include only those who meet the minimum standards for clinical quality measures. While our network has many outstanding professionals, the Select Care Network highlights AdvantagedCare Physicians (ACPNY), with high-quality outcomes on a number of Healthcare Effectiveness Data and Information Set (HEDIS) measures including diabetes care, colorectal screening and breast cancer screening.

In addition to quality measures, EmblemHealth considers the geographic location of the practitioners and the practitioner’s willingness to accept the rate structure necessary to meet the financial needs of the program. We consider where our members reside in relation to the locations of the providers when selecting practitioners for this network. This ensures our members have access to the number and types of clinicians needed within a reasonable distance from where they reside.

Hospitals

Hospitals were selected based on geographic location as compared to targeted market areas, a history of a strong working relationship with AdvantageCare physicians and EmblemHealth in other lines of business, provision of clinical services necessary to meet network adequacy requirements and a willingness to accept the rate structure necessary to meet the financial needs of the program.