Providers
Why work with FirstCare?
Like you, we are deeply committed to doing the right thing for the health of our communities. FirstCare is Texas-based and provider-owned, so we know what it means to deliver quality care, right here. We want doctors to be in charge of patient care. We’ll do everything we can to help you achieve better patient outcomes.
Partnering with FirstCare can connect you with more than 4,600 contracted facilities, including 199 hospitals, and more than 16,400 primary care and specialty providers. Our strong local ties can generate favorable new business — from commercial to government-employed patients — all at competitive, profitable rates. FirstCare has tremendous expertise in compliance, administration, and processing for STAR and CHIP programs. And we do it all with high ease of use, high reliability and low administrative hassle.
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Our Provider Relations Team is here for you. If you have questions, please contact your provider relations representative:
Corporate Medical Advisory Committee (CMAC)
The Corporate Medical Advisory Committee (CMAC) develops, reviews and approves clinical programs and guidelines, studies, and other clinical activities related to the health care services provided to FirstCare members.
The CMAC adopts evidence and approves clinical criteria on an annual basis. The specific functions and responsibilities of the committee are as follows:
- Provide regular clinical measurement oversight
- Identify and monitor key quality indicators that measure performance against clinical practice guidelines, external benchmarks and internal targets (HEDIS)
- Assist with review of clinical aspects of the Quality Improvement (QI) program, work plan, and the Care Management program
- Recommend new opportunities or changes in current programs and interventions to improve clinical care and service
- Assist with development, review and maintenance of clinical policies and procedures
- Review and analyze potential quality of care issues if required
- Review, assess, and recommend internal utilization management practices
- Approve the criteria used to review authorization decisions at least annually
- Review and approve the Utilization Management (UM) program description
- Evaluate utilization functions including the assessment and analysis of utilization statistics, management guidelines, referral trends, ambulatory treatment patterns, inpatient monitoring processes and the effectiveness of discharge planning programs
Committee Structure
The membership is comprised of the following:
- Chair: VP of Clinical Integration and Senior Medical Director
- Chief Medical Officer (CMO)
- Director of Behavioral Health Care
- Behavioral Health Medical Director
- VP of Care Management
- AVP of Quality Improvement (QI)
- Director of Care Management
- Regional Quality Managers (2)
- Clinical Quality Analysts
- Community Practitioners—These practitioners are selected to represent primary care and high volume specialties per region. It is recommended to appoint at least three (3) outside practitioners to the committee.
Quorum
Committee meetings are held a minimum of quarterly. All members have voting rights and a majority of the membership constitutes a quorum. Meeting minute reflect decisions made and are signed and dated. Meeting minute are confidential, approved prior to the next meeting, and stored in a secured area.
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