LouAnne Giangreco, M.D. is BCBSRI’s senior medical director, medical affairs. Dr. Giangreco joined us in 20 de julio22 and is helping to lead our clinical efforts to enhance our members’ experience, advance the quality of care they receive, address health inequities, and improve the well-being of all Rhode Islanders. Her diverse background includes experience as an emergency physician, as well as serving as System Chief Medical Officer of Cayuga Health System in Ithaca, NY and VP and Chief Medical Officer of Health Care Improvement at Excellus BlueCross BlueShield in upstate New York. A proven leader in healthcare transformation, Dr. Giangreco has also taught classes at Ithaca College and Cornell University as well as served as a consultant for a number of organizations.

One of the strengths of Blue Cross & Blue Shield of Rhode Island (BCBSRI) has always been the depth and quality of our participating provider network, particularly on a local level. We rely on your expertise and partnership to not only provide the highest-quality care to our members, but to help us shape our strategies, policies, and programs to allow for that care to happen while we work collaboratively to improve the health and well-being of members of our community.

Additional benefits include networking opportunities, a different perspective on the healthcare system, and developing skills for future leadership opportunities.

One of the ways this critically important function happens is through provider participation in our many external committees. Many of these groups are looking to add membership, and toward that effort we wanted to provide a summary of these committees, why they exist, and who to contact if you’re interested in joining.

Pharmacy & Therapeutics (P&T) Committee

Purpose and objectives:

• Oversees the creation of medication usage policies and promotes clinically appropriate safe and effective pharmacotherapy for corporation plan members for both medical and behavioral health treatment

Physician participation: The committee consists of a majority of individuals who are practicing physicians, practicing pharmacists, and other practicing healthcare professionals who are licensed to prescribe drugs. The physician members include a minimum of five contracted and board-certified network physicians, including at least one primary care provider (PCP) and three specialists, including a behavioral health physician. The pharmacist members include at least two community pharmacists. The P&T Committee is not currently looking for new members, but we welcome your interest to be able to call upon as specific needs arise.

Meets: Four times per year, or more if necessary

Contact if interested/for more information: LouAnne Giangreco, M.D.

Provider Credentialing Committee

Purpose and objectives: To ensure providers wishing to participate in the BCBSRI provider network have appropriate qualifications and meet credentialing requirements as set forth in the BCBSRI Credentialing Policies and Procedures (P&Ps). The committee reviews credentials, changes to practice, and appropriate regulatory/legal or disciplinary information for contracted providers during the recredentialing process and makes determinations on whether providers should continue to participate in the BCBSRI network. Lastly, the committee ensures Health Delivery Organizations (HDOs) wishing to participate in the BCBSRI network meet contracting requirements, including a quality assessment, as set forth in BCBSRI’s P&Ps.

Physician participation: A minimum of six community-based providers, including primary care and specialist providers, and behavioral health professionals. All providers must participate in the BCBSRI network and be in good standing. The Provider Credentialing Committee is currently looking for new members, including 1-2 physicians and 1 advanced practice provider (APP).

Meets: Via web conference twice per month, the second and fourth Tuesday at 7:30 a.m. May meet more often as required by new provider requests for credentialing or to hear provider appeals.

Contact if interested/for more information: Gus Manocchia, M.D.

Health Care Community Exchange Council (HCEC)

Purpose and objectives:

• Ensures providers have input in, and are informed of, health plan policies, priorities, and strategy.
• Reviews and announces health plan policy changes, health plan strategic initiatives, and community priorities.
• Ensures physician representatives of the BCBSRI board of directors receive direct input from a spectrum of network providers that will inform corporate strategy.

Physician participation: A broad cross section of providers as well as physician members of the BCBSRI Board of Directors. Membership is selected based on the committee’s needs for representation. Considerations will be given based on specialty type, practice type, and employer type (self-versus employed). Membership should include a minimum of 10 community-based providers, including primary care, specialists, and behavioral health professionals. Most providers must participate in the BCBSRI network. Non-BCBSRI members will serve a term of two years, and one-third will rotate on/off every two years. The HCEC is currently looking for new members, who must be willing to actively engage in discussions and share opinions/ideas.

Meets: Quarterly on the third Tuesday of the month from 6-7:30 p.m. (Next meeting is on 16 may)

Contact if interested/for more information: LouAnne Giangreco, M.D.

Professional Advisory Committee (PAC)

Purpose and objectives:

• Oversees the design and follow-through of clinical and preventive health monitoring and evaluation activities/studies and medical care standards (including preventive healthcare guidelines).
• Reviews appropriate policies and procedures.
• Reviews care that is of potentially substandard quality or presents patterns of inappropriate utilization.
• May be informed of provider disciplinary actions up to and including termination.
• May review disciplinary or sanction information from licensure authorities and practice patterns for contracted providers/healthcare delivery organizations.
• When appropriate, the committee may recommend implementing or continuing a corrective action, suspension, or termination of a contracted provider as outlined in the credentialing policies and procedures and in coordination with the Credentialing Committee.

Physician participation: A minimum of six community-based providers, including primary care providers and specialists. All providers must participate in the BCBSRI network. The PAC is currently looking for new members.

Meets: Generally every other month, remotely, third Wednesday of the month from 6-7 p.m.

Contact if interested/for more information: Kathy Calenda, M.D.

Behavioral Health Clinical Advisory Council (BHCAC)

Purpose and objectives:

• Identifies, develops, and has input on clinical guidelines that meet local, state and/or national standards and have the highest likelihood of improving outcomes for members who have mental health and substance abuse disorders.
• Approves standards for treating a broad range of mental health, substance use disorder, and intellectual and developmental disability diagnoses.
• May also review and recommend various Evidence Based Practices (EBPs) to be used throughout the network.
• Ensures a broad representation of providers (psychiatrists, psychologists, licensed clinical social workers, nurse practitioners, physician assistants, peer support, etc.) have input in the development and deployment of health policy to address community BH needs.
• Reviews and announces health plan policy changes, health plan strategic initiatives, and community priorities.
• Provides clinical consultation and expertise regarding complex member needs to optimize health outcomes upon request.

Physician participation: A broad cross section of a maximum of 10 community-based providers, including behavioral health professionals with specialties including but not limited to addiction medicine, geriatric psychiatry, IBH, pediatrics, autism, etc. All providers must participate in the BCBSRI network. The BHCAC is currently looking for one new member to diversify our participation, or a provider from Care New England.

Meets: A minimum of three times per year

Contact if interested/for more information: Victor Pinkes, M.D.

Musculoskeletal Care Specialist Advisory Council (MSK SAC)

Purpose and objectives: With an eye toward improving process, reducing barriers, closing gaps, and improving health outcomes, the MSK SAC seeks to reduce the amount of unnecessary spend associated with MSK care while improving upon the overall health of the population, enhancing the care experience, improving healthcare team well-being, and advancing health equity. Work expands across the MSK care continuum, from wellness programs to severe illness.

Physician participation: The MSK SAC works externally with the BCBSRI provider network to create meaningful change in the areas noted above, and is currently looking for new members.

Meets: Every two to three months

Contact if interested/for more information: Gus Manocchia, M.D.

¡Gracias!

In May there are several important medical observances: Mental Health Awareness Month, National Nurses Week (6 may-12), National Women’s Health Week (14 may-20), National Stroke Awareness Month, and many others. As always, thank you for your partnership and for all you do to help our members stay safe and healthy!