The national voice of managed care.
CMCA is dedicated to the promotion of ethical practices between health care providers and payors of health services and benefits. It is an essential component of protecting and preserving the health and financial security of health care in Canada. CMCA is a federally run, not-for-profit association that contributes to the integration of health care by offering its proprietary network of contracted providers, suggested program guidelines, and schedule of services under reference-based pricing (RBP) to payors of health care and benefits (plan sponsors). Contracted providers perform services under a delivery of care model that adheres to recommended and suggested program guidelines and schedules of services that meet the better business practices of providers’ professional associations and industry professionals. This model produces savings of 20-30% on all claimed services for payors. Payors are now able to produce savings, that enable funding, to improve and be introduced back into health care.
Contracted providers enrolling in the CMCA’s network become members as they accept the Suggested Program Guideline accompanied by their Schedules of Health and Dental Services under RBP. Program guidelines and the schedule of health and dental services under RBP are consistent with each provider's discipline and/or scope of practice as they vary in each province.
The CMCA becomes the licensor of its providers' network as it licenses it out to its management umbrella, First Canadian Benefits (FCB). FCB’s Procurement Committee is responsible for entering into contracts and agreements with payors seeking employee benefits through network solutions. All agreements and dispute resolutions are reviewed and accepted under governance by a panel of board members representing the CMCA’s territorial bodies. Example: Ontario Managed Care Association (OMCA).
The CMCA’s proprietary network, suggested program guidelines, and its schedule of health and dental services under RBP is away from common ownership and is a not-for-profit care model. It organizes health care by facilitating changes and renewing the social contract to maintain its professional status. Making necessary reforms to preserve the economic viability of health care under institutional ethics and jurisprudence.