Governance Oversight Committee must include hospital CEO, CFO, CMO, a consumer representative, and must comprise at least 50% physicians. See the Participation Agreement for additional detail regarding requirements of the Oversight Committee. Provide the names of your Oversight Committee members and their organization. Please check one to indicate who the member is Job Title and representing: Name, Credentials Organization, if Hospital Physician Consumer applicable Employee Representative Representative Mary Smith Program Coordinator Ann Black, MD CMO, Internist Frank Brown CFO CEO, Administrative William White oversight Sally Doe Sara Glass, DO Orthopedic Surgeon Bob Johnson, MD Pulmonologist Rick Williams, MD General Surgeon Bruce Jones, MD General Surgeon Provide an explanation of how the Oversight Committee will provide oversight, guidance, and management to the program. Detail the process as well as expected meeting frequency. Please answer the following questions about how the Care Redesign Program Oversight Committee will provide oversight, guidance, and management to the Complex and Chronic Care Improvement Program. How often will the Oversight Committee meet? (monthly, bi-monthly, quarterly, bi-annually) Quarterly Does the member composition of your Oversight Committee meet the qualifications outlined Yes in the Participation Agreement? Will the Oversight Committee be provided with progress/dashboard reports on program Yes performance from hospital personnel involved in the program? If yes, how often will the Oversight Committee require these reports? (monthly, bi-monthly, Quarterly quarterly, bi-annually, annually)
Governance Oversight Committee must include hospital CEO, CFO, CMO, a consumer representative, and must comprise at least 50% physicians. See the Participation Agreement for additional detail regarding requirements of the Oversight Committee. Provide the names of your Oversight Committee members and their organization. Name, Credentials Job Title and Organization, if applicable Please check one to indicate who the member is representing: Hospital Employee Physician Representative Consumer Representative Mary Smith Program Coordinator Ann Black, MD CMO, Internist Frank Brown CFO William White CEO, Administrative oversight Sally Doe Sara Glass, DO Orthopedic Surgeon Bob Johnson, MD Pulmonologist Rick Williams, MD General Surgeon Bruce Jones, MD General Surgeon Provide an explanation of how the Oversight Committee will provide oversight, guidance, and management to the program. Detail the process as well as expected meeting frequency. Please answer the following questions about how the Care Redesign Program Oversight Committee will provide oversight, guidance, and management to the Complex and Chronic Care Improvement Program. How often will the Oversight Committee meet? (monthly, bi-monthly, quarterly, bi-annually) Quarterly Does the member composition of your Oversight Committee meet the qualifications outlined in the Participation Agreement? Yes Will the Oversight Committee be provided with progress/dashboard reports on program performance from hospital personnel involved in the program? Yes If yes, how often will the Oversight Committee require these reports? (monthly, bi-monthly, quarterly, bi-annually, annually) Quarterly
HCIP-IP-Sample-20170110.docx