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Accreditation/Certification - A review process that hospitals and other health care facilities go through voluntarily to identify and correct problems and improve the safety and quality of the care and services they provide. Several different agencies set these standards and offer accreditation/certification programs. We collect information on a hospital or other facility’s accreditation/certification when it joins our network and every 3 years afterward. We verify the information each time, either by contacting the accrediting/certifying agency directly or through a copy of the approval letter or report provided by the facility.
Adolescent immunizations - The percent of the primary care provider's (PCP) Priority Health members who received a complete vaccine series by their 13th birthday. Immunizations can prevent serious childhood illnesses.
Adult physical exams - The percentage of the primary care provider's (PCP) Priority Health members ages 41 and older who received a physical examination in the most recent two-year period.
Advice on avoiding illness - The percent of Priority Health members in the primary care provider's (PCP) practice group who responded "excellent" or "very good" when asked to rate the advice they received during their office visit about ways to avoid illness and stay healthy.
Antibiotic resistance - The percentage of Priority Health child members with ear infections, in the primary care provider's (PCP) practice group, who were treated with first-level antibiotics or no antibiotics. Proper treatment of ear infections can lessen long-term resistance to antibiotics.
Asthma care - The percent of Priority Health members with asthma in the primary care provider's (PCP) practice group who properly use long-term control medications. Long-term control medications help reduce the inflammation that causes asthma attacks.
Board certification -
Certified: A doctor who is board-certified has:Eligible: a doctor who is board-eligible has:
- Received training from an approved residency program
- Voluntarily taken and passed a comprehensive test of his or her knowledge in a specialty
- Met the other requirements set by the board that gives the test
No certification: a doctor who is not board certified or board-eligible
- Completed an approved residency
- Qualified to take a comprehensive test to become board-certified, but has not yet taken it
Not applicable: board certification is not available to this type of provider.
We collect board certification information when a doctor joins our network, and every 3 years afterward. Each time, we verify this information with a primary source.
- You can check the most current board certification status at the American Board of Medical Specialties website, www.abms.org. The service is free, but you will have to register and log in.
- You can also check current board certification status for most DO physicians for free at www.osteopathic.org.
Breast cancer screening - We measure the percentage of the primary care provider's (PCP) Priority Health female members ages 40-69 who have had a mammogram within the past two years. Mammography screening can find breast cancer early.
Cervical cancer screening - We measure the percentage of the primary care provider's (PCP) Priority Health female members ages 18-64 years old who had a Pap test within the past three years. Pap tests can find cervical cancer early.
Childhood immunizations - The percent of the primary care provider's (PCP) Priority Health members who received a complete vaccine series by their second birthday. Immunizations can prevent serious childhood illnesses.
Children's physical exams - The percentage of the primary care provider's (PCP) Priority Health members between ages 3 and 6 who received an annual physical examination.
Chlamydia screening - We measure the percentage of Priority Health sexually active female patients ages 16-25 of a health care provider's practice group who received a chlamydia test during the year. Early detection and treatment of chlamydia can prevent pelvic inflammatory disease and sterility among young adults.
Depression - The percent of Priority Health members with depression in the primary care provider's (PCP) risk group who received appropriate follow-up care after being prescribed antidepressant medications. The appropriate follow-up care is essential for managing depression and potential complications.
Diabetes care -The combined percent of Priority Health members with diabetes in the primary care provider's (PCP) practice group who had an HbA1c result less than or equal to 7%; an LDL-C level less than 130; a retinal eye exam; and/or a screening for nephropathy. Proper management of diabetes leads to fewer health problems associated with diabetes.
Disease management - Patients with chronic (long-term) illness face daily challenges to stay healthy. Proper management of illness like diabetes, asthma and depression can help patients live a higher quality life, be more productive at work, and prevent small problems from becoming bigger. Illness can be managed by seeing a doctor regularly, taking prescribed medications as ordered, and getting laboratory tests ordered.
Only primary care providers (PCPs) who have 100 or more Priority Health patients are eligible to be measured in the disease management category. Providers are measured as a practice group (all participating doctors in one office receive the same rating), except for depression, when they are measured as a Risk Group.
Facility - The name of the hospital, care center or other building name provided to us by the health care provider. We do not verify this information.
Fellowship - A doctor who has finished medical school, residency and who is training for a very specialized area of medicine.
Gender - The information on whether a person is male or female is provided by health care providers when they apply to participate in our networks. We do not verify this information.
Hospital affiliation - All hospitals where the doctor or other health care provider has affiliations. The primary hospital affiliation (indicated by the *) is the hospital where a doctor will usually admit a patient or send a patient for services. We collect this information from them when they join the network and again at least every 3 years; these affiliations are self-reported and not otherwise verified.
Internship - A one-year period of training immediately following medical school.
Medicare participant - Doctors who accept Medicare payment will see patients who have Medicare coverage. This is important because patients with Medicare coverage may pay more to see doctors who do not participate with Medicare.
Other medical interests - Other areas of medicine that the doctor or other health care provider has interest and/or knowledge. This information is volunteered to us, and not all treatments listed under "Medical Interests" are covered benefits by Priority Health. Refer to your coverage documents for specific benefit information.
Overall satisfaction - The percentage of Priority Health members in a primary care provider's (PCP) practice group who responded "excellent" or "very
good" to a question about the Overall Quality of Care and Services.
Patient satisfaction - Satisfaction with services received by health care
providers and their office staff is important for many patients. Timely
access, friendly service and professional care affect a provider's overall
rating of quality care and service. Satisfaction is measured by the percent
of members who rate their provider's quality of care as "excellent" or "very
good."
Only primary care providers (PCPs) with 100 or more Priority Health patients
are eligible for measurement in patient satisfaction measures. Providers are
measured as a practice group, meaning that all doctors and practitioners
belonging to a single practice receive the same rating.
Physician - This information is provided by the health care provider when they apply to participate in our networks. We do not verify this information.
POS A, POS B - These are two slightly different versions of the PriorityPOSSM health plan. POS A refers to the network used by the traditional fully funded point-of-service (POS) plan, where for a set premium per member, Priority Health covers both the administrative and the medical costs of all members. POS B refers to the network used by the self-funded and shared funded versions of the POS plan, where the members' employer covers all or part of the medical costs. This information will be on the member's ID card beginning in early spring 2009; until then, members can contact their employer or Priority Health Customer Service (800 446-5674) to find out whether their plan is POS A or POS B.
Practice group -
A group of doctors and/or other health care providers who practice together, generally out of the same location.
Practice name -
The business name used by a doctor or health care provider, or by a group of health care providers. Some large practices have many practice groups in different locations, all sharing one practice name. Doctors and other providers give us their practice names when they join our network, and every 3 years afterward. We do not do other verification of this information.
Preventive health - Regular preventive care can keep you from getting sick or help
you and your doctor spot illnesses early so that they can be more easily
treated. Examples of preventive care include immunizations and cancer
screenings.
Only primary care providers (PCPs) with 100 or more Priority Health patients
are eligible for measurement in preventive health.
Professional degrees
|
ACSW: Academy of Certified Social Workers - A certified social
worker meeting specific requirements in supervised social work
experience and reference ratings. Also has passed the ACSW written
examination. Note: Not all eligible social workers voluntarily achieve
this designation.
|
| CNM: Certified Nurse Midwife - A registered nurse who has received additional training as a midwife, delivers infants, and provides antepartum and postpartum care |
| CSW: Certified Social Worker - An individual registered as a Certified Social Worker with the State of Michigan Department of Consumer & Industry Services. |
| DC: Doctor of Chiropractic - a specialist licensed in a system of therapy which holds that disease results from a lack of normal nerve function and which employs manipulation and specific adjustment of body structures (as the spinal column). |
| DDS: Doctor of Dental Surgery - A specialist licensed in dentistry. |
| DMD: Doctor of Dental Medicine - A specialist licensed in dentistry. |
| DO: Doctor of Osteopathic Medicine - The degree a person receives after completing four years of medical school. A doctor of osteopathic medicine is licensed in the system of medical practice based on a theory that diseases are due chiefly to loss of structural integrity, which can be restored by manipulation of the parts supplemented by therapeutic measures (as in the use of medicine or surgery). After completion of medical school, a doctor of osteopathic medicine chooses an area of medicine to specialize in a Residency. |
| DPM: Doctor of Podiatric Medicine - A specialist licensed in the medical care and treatment of the human foot. |
| Ed.D.: Doctor of Education - The degree a person receives after completing a four-year post-graduate program specific to their field. For example, psychology. |
| LLP: Limited Licensed Psychologist - An individual issued a limited license by the State of Michigan Department of Consumer & Industry Services to practice psychology. A person with this license practices under the supervision of a licensed psychologist. |
| LMSW: Licensed Master of Social Work - The degree and license a person receives after completing a graduate-level program in social work. |
| LPC: Licensed Professional Counselor - An individual issued a license by the State of Michigan Department of Consumer & Industry Services to practice counseling. |
| MA: Master of Arts - The degree a person receives after completing a graduate-level program specific to their field. For example, counseling or psychology. |
| MD: Medical Doctor - The degree a person receives after completing four years of medical school. A medical doctor is licensed in the science and art of dealing with the maintenance of health and the prevention, alleviation, or cure of disease. After completion of medical school, a medical doctor chooses an area of medicine to specialize in and completes a Residency. |
| MS: Master of Science - The degree a person receives after completing a graduate-level program specific to their field. For example, counseling or psychology. |
| NP: Nurse Practitioner - A registered nurse who through advanced training is qualified to assume some of the duties and responsibilities formerly assumed only by a physician. |
| OD: Doctor of Optometry - A specialist licensed to practice the art or profession of examining the eye for defects and faults of refraction and prescribing especially corrective lenses or exercises. |
| PA, PA-C: Physician Assistant, Physician Assistant - Certified - A specially trained person who is certified to provide basic medical services (as the diagnosis and treatment of common ailments) usually under the supervision of a licensed physician. |
| Ph.D.: Doctor of Philosophy - The degree a person receives after completing a four-year post-graduate program specific to their field. For example, clinical psychology. |
| Psy.D.: Doctor of Psychology - The degree a person receives after completing a four-year post-graduate program in psychology. |
Recorded BMI - We measure the percentage of Priority Health patients of a health care provider's practice group who have their body mass index (BMI) calculated and recorded during an office visit. BMI assessment can identify patients who are overweight or obese. These conditions increase the risk of many diseases and health conditions, including diabetes, heart disease and stroke.
Residency - A period of
advanced medical training and education that normally follows graduation
from medical school and licensing to practice medicine and that consists of
supervised practice of a specialty in a hospital and in its outpatient
department and instruction from specialists on the hospital staff.
Satisfaction with access to PCP - We ask Priority Health patients to rate their satisfaction with the time between their call for an appointment and the time when the first appointment was available.
School - The school where the
practitioner attended before post-graduate education and before starting to
practice medicine. For doctors, this would be their Medical School.
Secondary languages - Languages other than English that the
practitioner or someone who works at the practitioner's office may speak.
Why is this important to members? It is important for patients and
practitioners to understand each other for optimal treatment. Interpreters
assist with clear communication when language barriers exist. We collect this information from the practitioners when they join our network and then every 3 years afterward. This information is not otherwise verified.
Self-funded - A plan set up so the employer pays
all employee health care costs directly. Priority Health manages these plans
but does not fund them.
Specialty - The specific area of medicine in which a practitioner has been trained. We collect specialty information when practitioners join our network and verify their training with a primary source. This information is not verified again unless the practitioner requests a change in specialty.
Supervising physician - A physician who supervises resident physicians. If you
choose this practitioner, it is highly likely that a resident in training
will take care of your health care needs. When choosing an attending
physician as your PCP, his/her name will appear on your member ID card. If
you get a referral to a specialist, it is highly likely that a resident will
provide your specialty care. To understand the benefits of choosing a
residency training program for your health care needs, please feel free to
call the number listed for the attending or supervising physician.
Tobacco screening - The percent of
Priority Health members or parents of children in the primary care provider's (PCP) practice group who were asked if they used tobacco and were
advised to quit using tobacco.
Time to return phone calls -
The percent of Priority Health members in the primary care provider's (PCP)
practice group who responded "excellent" or "very good" when asked to rate
the length of time it takes to receive a return call when asking for medical
information or advice.
