A Positive Member Experience For You

A Positive Member Experience For You

Provider and Hospital Networks

We use the following network design criteria to select our providers including hospitals, clinics and physicians to ensure the most positive member experience possible: 

Physician Providers

L.A. Care’s physician provider network for L.A. Care Covered™ and L.A. Care Covered Direct™ is designed based on specific criteria that determines the selection of the Participating Physician Groups (PPGs) and other physician providers. Physician providers are selected to provide Members’ access to multiple specialties, including but not limited to: Allergy, Cardiology, Ophthalmology, Gastroenterology, General Surgery, Nephrology, Neurology, Obstetrics and Gynecology, Orthopedics, Pulmonology, and Urology. This design ensures members have access to a large number of physicians in different fields/specialties within a 15-mile radius or 30 minute driving time from their residence.

All physician providers, including specialists, must meet L.A. Care’s applicable credentialing requirements.

L.A. Care evaluates, on an ongoing basis, physician providers in its network for quality measures and requires physician providers, such as primary care physicians, to meet minimum clinical quality measures in many areas of care including:

  • Preventive services (e.g. childhood immunizations, health screenings)
  • Managing chronic diseases (e.g. diabetes and asthma)
  • and Prenatal and Postpartum Care.

Certain physician providers are also evaluated on Member experience measures, such as getting timely appointments and how timely Members’ questions are answered when they contact the physician provider’s office.

In designing its criteria, L.A. Care reviews and incorporates nationally recognized measures, including those developed by the National Committee for Quality Assurance and the National Quality Forum.

L.A. Care does not use cost-related measures to select physician providers for its network.

L.A. Care uses the same physician criteria for all networks for all plans.

Hospital Providers

L.A. Care’s hospital network for L.A. Care Covered™ and L.A. Care Covered Direct™ is selected based on specific criteria in compliance with applicable regulations and incorporating nationally recognized measures. These criteria also include:

  • Meeting certain Member needs, including Hospitals’ proximity to a Member’s residence (generally, within a 15-mile radius of the Member’s home)
  • Admitting privileges of physician providers who care for Members
  • and licensure and accreditation status, including being accredited by The Joint Commission, an independent, nationally recognized not for profit body whose accreditation/certification is recognized as a symbol of quality that reflects a hospital’s commitment to meeting certain performance standards.

L.A. Care does not directly use quality measures, member experience measures, patient safety measures or cost-related measures prior to selecting a hospital for its network. However, L.A. Care generally requires its network hospitals to be accredited by The Joint Commission which may include patient satisfaction surveys as part of its accreditation standards.

L.A. Care uses the same hospital criteria for all networks for all plans.