Yale-New Haven Community Medical Group

General information
The Yale-New Haven Community Medical Group (CMG) was created in January 2004, reformed from its predecessor organization, the Yale-New Haven Medical Staff IPA, to include community based members of Yale-New Haven Hospital (YNHH) Medical Staff. Approximately 720 members of the YNHH active Medical Staff are also members of the CMG.

CMG Board of Directors and Administration
The CMG is governed by a nine member Board of Directors for the purpose of managed care contracting and clinical integration (CI). Board members are elected from the membership at large and are listed below. Board members serve a three year term and are eligible to be re-elected for a maximum of three terms (9 years). Dr. Craig Summers currently serves as president of CMG. General administration for the CMG is provided by Lisa Edwards, director, clinical integration and Alexis Cort, director, administration and technology.

CMG Board of Directors

• Paul Barcewicz, MD, Surgery
• Michael Berman, MD, OB/GYN
• Agnes Czibulka, MD, Surgery
• Phillip Dickey, MD, Neurosurgery
• Fredric Finkelstein, MD, Internal Medicine
• Karen Brown, MD, Internal Medicine
• Michael Rubinstein, MD, Internal Medicine
• Alan Siegel, MD, Psychiatry
• Craig Summers, MD, Pediatrics

Committees
The CMG has a Credentials Committee which reviews applicants' and existing members compliance with CMG activity requirements (See CMG Requirements below) and a Technology Committee which focuses upon means by which the CMG can assist its members in advancing technology in their practices. Additionally, several committees are involved in the development of clinical integration programs. A list and the respective chairs of the CMG committees are identified below:

For further information about the committees listed above, please visit the CMG website.

CMG Credentials Committee
The CMG Credentials Committee is composed of CMG members in representative specialties. The committee meets monthly and is responsible for reviewing the applications of new and re-credentialed members of the CMG. The committee delegates authority for verification of credentials to the YNHH Credentials Committee and focuses its work on reviewing CMG applicants and re-applicant's compliance with the CMG specific requirements described below.

CMG membership
The CMG credentials physicians, podiatrists and dentists for membership. Complete requirements and process for new and re-credentialing of CMG prospective and existing members are fully described in the New Member Credentialing Policy and Procedure and the Re-Credentialing Policy and Procedure.

New applicants who, at the time of their application, have been in practice in the New Haven area for less than one year are approved for a one year provisional membership.

New members are notified that they have one year to fulfill the CMG requirements. Applicants are re-reviewed for continued membership at that time.

Existing CMG members must fulfill CMG requirements on an ongoing basis. Compliance is reviewed every two years concurrent and with the same application process used in re-appointment to the YNHH Medical Staff.

CMG contracted health plans
The CMG contracts with the health plans listed below:

• Aetna*
• Colonial Cooperative Care*
• Connecticare
• HMC-PPO*
• Health Care Value Management*
• Great-West Healthcare (One Health Plan)*
• Private Health Care Systems*
• United Healthcare*

CMG requirements
The CMG requires that its members fulfill criteria in the areas of clinical activity, teaching or administrative activity, and network connectivity. Activities must be at or related to Yale-New Haven Hospital.

Members are required to provide documentation of having fulfilled these criteria at the end of their one year provisional membership and every two years thereafter concurrent with their YNHH re-appointment date.

For full description of the requirements, please refer to the New Member Credentialing Policy and Procedure and the Re-Credentialing Policy and Procedure.

Medical Staff Category
Members of the CMG must maintain membership on the YNHH Active Medical Staff in order to be and remain eligible for CMG Membership. The Medical Staff categories of "attending" and "associate" are considered Active staff.

Clinical Criteria
Clinical criteria for each specialty area are indicated in the documents below. The clinical criteria mirror the requirements for a member of the YNHH Medical Staff to remain on the hospital's Active (attending or associate) staff and consist of a specific number of admissions/discharges/cases, consultations or inpatient visits depending upon the area of practice.

Teaching/administrative criteria
CMG members must also participate in some teaching and/or administrative activity relative to YNHH. The list below indicates some examples of activities that would fulfill this requirement:

Teaching activities

1. Precepting Yale University medical, physician assistant or nursing students or YNHH resident physicians in the private office setting.
2. Attending in resident or fellow clinics or other YNHH network facilities or clinics at YNHH or the West Haven VA Medical Center
3. Inpatient attending at YNHH or WHVAMC
4. Giving lectures to Yale medical students or YNHH resident physicians
5. Conducting Grand Rounds or other teaching conferences
6. Attending morning report for YNHH inpatient services
7. Other sectional, departmental, or YNHH teaching activities as approved by the Credentials Committee
8. Attending in Yale-New Haven Medical Staff YNH-CMG floating clinic
9. Conducting lectures or other educational programs in YNH-CMG disease management initiatives
10. Other community service programs then approved by the YNH-CMG Credentials Committee

Administrative activities

1. YNHH Medical Board or committees of the Medical Board (i.e. Tissue, Infection Control, Credentials, Ethics, Operating Room, etc.)
2. Departmental committees
3. Quality assurance activities of the member's respective department or YNHH YNH-CMG Clinical Integration Committees
4. Board or committees of the YNHH Medical Staff YNH-CMG
5. Other sectional, departmental or YNHH or YNH-CMG administrative activities as approved by the Credentials Committee

Network connectivity
Members of the YNH-CMG are also required to demonstrate network connectivity through one of the means listed below:

1. Participation in MDlink or related system or
2. Fax of summary reports to and from related system or Yale New Haven Hospitalist Team or
3. Electronic medical record in use in private practice or
4. Other CI communication systems as applicable to capture quality and control costs as approved by the Credentials Committee.

Members will be asked to report on their network connectivity at the time of re-credentialing and to provide evidentiary documentation.

CMG credentialing and application process
The CMG is contracted with the YNHH Department of Physician Services for the provision of credentialing services for the CMG. The Department of Physician Services has obtained delegated credentialing from the CMG contracted health plans as indicated with a * under CMG contracted health plans.

For those plans with delegated credentialing, the credentialing application materials you complete for the YNHH Medical Staff may be able to be utilized for CMG credentialing (see A and B below).

Recredentialing application materials that you complete for the YNHH Medical Staff are always utilized for CMG and those health plans with which you participate through the CMG.

Application Submission
At this time, electronic submission is not available. You must, therefore, print out all forms and submit them in hard copy. All materials should be submitted to the following address:

Yale-New Haven Community Medical Group
Yale-New Haven Hospital, Dept. of Physician Services
20 York Street, Hunter 4
New Haven, CT 06510

Materials may be submitted via U.S. Postal Service, Federal Express or in person. The Department of Physician Services is located on the fourth floor of the Hunter Radiation Therapy Building. For specific directions, please call (203) 688-2615.

Applicant categories

A.
Individuals with YNHH Medical Staff Applications in process or whose YNHH appointment was less than one year ago.

• Your YNHH Medical Staff application will serve as your CMG application.
• An application fee of $100 (waived for Primary Care Providers) must be provided in order to begin processing. Please be sure to submit a check or money order along with your materials.
• Submit a signed W-9 Form
• Submit a signed Participating Practitioner Agreement and be sure to read the Amendment to Appendix B of the Participating Practitioner Agreement
• Opt-in forms corresponding to the health plans with which you are interested in participating: Aetna, Colonial Cooperative Care, Health Care Value Management, HMC-PPO, Great-West Healthcare (One Health Plan), Private Health Care Systems, United Healthcare
.

• Once your application is received, you will be contacted in regard to any additional information to supplement your YNHH Medical Staff application that may be required for CMG membership.

B.
Individuals who were appointed to the YNHH Medical Staff more than one year ago.

• Complete, sign and date the Yale-New Haven Community Medical Group Application
• An application fee of $100 (waived for Primary Care Providers) must be provided in order to begin processing. Please be sure to submit a check or money order along with your materials.
• Submit a signed W-9 Form
• Submit all materials listed in the CMG Full Application Checklist.
• Complete Claim-Suit Report Form if you have answered "yes" to question #17 on the application
• Submit a signed Participating Practitioner Agreement and be sure to read the Amendment to Appendix B of the Participating Practitioner Agreement
• Opt-in forms corresponding to the health plans with which you are interested in participating: Aetna, Colonial Cooperative Care, Health Care Value Management, HMC-PPO, Great-West Healthcare (One Health Plan), Private Health Care Systems, United Healthcare
.

 

Important notes: (1) Opt-in forms and their attached contract appendices reference the Yale-New Haven Medical Staff IPA, this organization was re-named as the Yale-New Haven Community Medical Group in January, 2004. (2) ConnectiCare requires an original copy of their application. If you are interested in participating with ConnectiCare, please contact the CMG office at (203) 688-2615. Once complete, the ConnectiCare application should be returned directly to the address identified above.

• Once your application is received, you will be contacted in regard to any additional information to supplement your YNHH Medical Staff application that may be required for CMG membership.

Approval process
Following receipt of your application materials and approval of your membership on the Yale-New Haven Hospital Medical Staff, your application will be forwarded to the CMG Credentialing Committee, and then to the CMG Board of Directors, for consideration. Once complete, applications for individuals who are already members of the YNHH Medical Staff will be forwarded directly to the CMG Credentials Committee. Please note that only complete applications will presented for membership determination. Be sure to provide all materials that have been requested.

Applicants are entitled to request the status of their credentialing applications, as described in the Applicant/Members Access to Files and Correction of Information Policy.

The process utilized by the CMG ensures that credentialing is conducted in a manner that is non-discriminatory. Membership determinations are not based upon the applicant's age, race, gender, ethnicity, sexual orientation, types of patients served or types of procedures performed. YNHH Department of Physician Services staff and members of the Yale-New Haven Community Medical Group Credentials Committee and Board of Directors sign nondiscriminatory agreements to acknowledge their understanding of and compliance with this policy.

Further information about the CMG is available via the CMG website.

Last revised: Dec. 6, 2006 (dh)

Home page URL: http://www.ynhh.org

All information is intended for your general knowledge and is not a substitute for medical advice or treatment for specific medical conditions. You should seek prompt medical care for any specific health issues and consult your physician before starting a new fitness regimen.