The committee reviews the Quality Improvement Program Description to ensure that it includes indicators , studies , and focused interventions that improve clinical and service quality , as well as , new and existing industry payment policies related to patient care . The committee provides suggestions for the design of Quality Improvement studies , disease management programs and clinical action plans .
To guide utilization management , the committee reviews over-and underutilization of services and the consistency of utilization review criteria . The committee reviews MCG ( formerly Milliman Care Guidelines ) and Hayes Technology criteria on a yearly basis . This committee reviews and recommends preventative care and disease specific treatment guidelines that are disseminated to the network providers .
The committee reviews and approves new medical technology or new applications of established technologies .
Pharmacy and Therapeutics Committee
The Pharmacy and Therapeutics Committees meet every quarter and is composed of Network Pharmacists and Physicians and is staffed by the Manager of Pharmacy Services , as well as the Hometown Health Chief Medical Officer , and Medical Director .
The HometownRx committee evaluates new and existing pharmaceutical therapies and recommends therapies for inclusion / exclusion for the Hometown Health Commercial Drug Formularies . The Senior Care Plus Formulary management process is managed by the Pharmacy Benefit Manager ( PBM ), MedImpact . The Manager of Pharmacy Services and Pharmacy Staff attends the Medicare Advantage Pharmacy and Therapeutics meetings remotely .
Medical Affairs Committee
The Medical Affairs Committee meets as often as necessary ( at least quarterly ) and is composed of participating and non-participating providers who perform peer review activities on the files presented for credentialing and re-credentialing review . Facility credentialing is also a responsibility of this committee .
This committee reviews the credentialing and re-credentialing of Hometown Health providers . In addition , they review and approve the policies and procedures for credentialing and re-credentialing practitioners , facilities , and healthcare
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