Practitioners


Our network of In-Plan practitioners includes primary care providers, medical specialists, and behavioral health providers.

We have availability standards for geographic distribution of primary care providers and high volume specialists. High volume specialties include: obstetrics & gynecology, dermatology, ophthalmology, orthopedic surgery, and otolaryngology. Our standards ensure that our members have access to these providers within a reasonable distance.

To ensure quality, assessment of the performance of all practitioners is included in the credentialing and re-credentialing process. Performance is re-assessed on an ongoing basis through the review of objective evidence from the following sources:  

  • Medicare and Medicaid sanctions
  • Sanctions or limitation on licensure
  • Member complaints
  • Identified adverse events
  • Quality issues
  • Utilization management issues
  • Malpractice history above the threshold

Hospitals

We select hospitals for our In-Plan network of hospitals based on access and quality. We make sure that our network of hospitals provides our members with access to hospitals within a reasonable distance and/or time. To assure quality we verify the accreditation of our in-network hospitals. Accreditation is a process of evaluating an institution/facility to determine whether it meets the standards set up by the accrediting body, and granting recognition of the fact. Accreditation is a process performed by a non-governmental agency at the request of the institution. We validate the accreditation of Health New England participating hospitals and Health Delivery Organizations (HDO) on initial credentialing and at least every three years through one of the following primary sources: