The OMCA is a governance panel of professionals that provides dispute resolution, guidance, and direction in procurement agreements utilizing the Canadian Managed Care Association’s Health Network of Providers, Schedules of Services, and its Suggested Program Guidelines under Reference Based Pricing (RBP).

 The OMCA is a not-for-profit Ontario-based organization comprising of a panel of professionals that have been appointed by their respective associations, colleges, and corporate industry.

Its primary role is to protect and provide clarity to the recommendations put forth by industry advisors and professionals concerning the management of health care services and benefits. It is responsible for reviewing, suggesting, amending and approving all procurements within its health network utilizing RBP under a governance model. Additionally, it represents complaints and issues arising with providers, payors, and third parties. It oversees and directs all day-to-day activities to its in-house manager, the First Canadian Benefits (FCB) Health Network.

It is a structure that provides accountability as it improves operations between corporate and clinical practices. There is a strong interconnection between corporate and clinical governance because the revenue cycles and reimbursement policies fall under corporate governance and they directly affect reimbursement monetary and risk management activities in clinical governance.

Corporate governance encompasses matters such as accounting, finance, investments, human resources, information technology, facilities, security, practice processes, health care procedures, and other structures that inevitably support patient care and meet compliance obligations. Clinical governance incorporates structures that allow continual assessment and monitoring of clinical risk to achieve the best possible clinical outcomes.

Disclaimer

The Health Network is in compliance with its obligations under the Competition Act. The Health Network is purely voluntary for providers and suggestive in nature. Providers are free to choose to accept enrolment in the Health Network with no specific prerequisites expected of the provider.

The Health Network does not facilitate price collusion, has no compulsory directives regarding the practice of health care, and does not dictate in any manner what health care treatment should be performed by a provider. The choice of what treatment is to be rendered remains exclusively in the professional discretion of the provider in consultation with, and subject to, the consent of the patient. The Health Network is away from common ownership as it works under a governance model recommended by, and consisting of, a panel of health care professionals and industry advisors.

All procurements are represented by FCB’s management team for review, consultation, consideration, recommendations, and/or amendments for approval by the Governance board.