How We Build Our Network

Florida Health Care Plans (FHCP) offers our directories with important resources to help you find any type of health care provider who participates in your specific health insurance plan.

Provider networks include:

• Hospitals
• Primary care physicians
• Specialists
• Urgent care centers
• Imaging centers
• Laboratories
• Home health agencies
• Pharmacies
• And many other services and health care providers

FHCP considers several factors when selecting providers to participate in our provider networks. Our criteria include availability and access of the provider, the quality of the provider’s services, and patient experience with the provider.

Provider Availability

FHCP works to ensure we have enough in-network health care providers for our members. Every year, we review our networks by looking at the location of our in-network health care providers based on where our members live and the number of health care providers compared to how many members we have, so there is a balance. Included in the review are:

• Primary care physicians
• Commonly used specialists
• Hospitals
• Urgent care centers
• Behavioral health specialists

Provider Ease of Access

FHCP considers this a standard based on guidelines issued by the Center for Medicare and Medicaid Service (CMS) and any state regulations related to health care provider networks based on how long it takes to get an appointment and other factors. Every year, FHCP reviews access to primary care physicians, commonly used specialists, and behavioral health specialists. If we determine that members do not have sufficient access to health care providers their needs within a reasonable timeframe, we add more providers to the network.

Doctors and other health care practitioners selected for FHCP’s network must pass a thorough credentialing process. The process verifies the health care provider’s qualifications, and includes checking education and training, licensure, board certification, malpractice claims history, and other background information. Doctors are reevaluated at least every three years. Providers in our Medicare Directory must also be participating in good standing with Medicare.

Quality

FHCP considers other efficiency, effectiveness, and outcomes measurements when enough information is available about a doctor. For example, how primary care physicians perform on nationally recognized measurements such as Healthcare Effectiveness Data Information Set (HEDIS) and whether patients receive appropriate health screenings for breast cancer, colorectal cancer, cervical cancer, etc.

Cost

Health care providers and hospitals must be willing to agree to a negotiated rate to participate in FHCP’s network. These agreed-on rates are a big advantage of having health insurance and seeing an in-network provider. In some cases, FHCP looks for health care providers who are willing to agree to reimbursement arrangements that reward them for meeting certain performance standards or outcome metrics for their patients.

FHCP currently does not utilize any specific quality measures other than credentialing standards to evaluate doctors and hospitals participating in our networks.

Patient Experience

FHCP makes a priority of contracting with doctors who can admit patients at our participating in-network hospitals. This means the doctor has a relationship with a specific hospital and is allowed to admit their patients there, which helps members go to an in-network hospital when needed. If you use a hospital for non-emergency care that is not in FHCP’s network, FHCP may pay less or may not pay for the services you receive.

FHCP also considers member complaints received about specific doctors, hospitals, and other health care providers when deciding whether to continue a provider’s contract with our network. We regularly conduct surveys regarding patient experience with primary care and specialty doctors who participate in our network.