Find a Health Provider - Glossary

Accepting New Patients- Practitioner accepts both new patients and current patients who change from other health plans to Priority Health.

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 member's ages 41 and older who received one 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 advice received during their office visit about ways to avoid illness and stay healthy.

Antibiotic Resistance - The percentage of Priority Health children 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: Doctors with board certification have passed a comprehensive test by a medical specialty board. A doctor voluntarily chooses to take this test.

Board Qualified - a doctor who meets the following:

• Graduated from medical school
• Completed an approved residency
• Trained under supervision in a specialty
• Qualified to take a test by a medical specialty board

No Certification: a doctor who is not board certified or board qualified

No Certification (Exception): a doctor who is not board certified or board qualified but meets certain exception requirements that allow the doctor to join Priority Health's network

Not Applicable: board certification is not available

Why is this important to members? If a doctor is board certified, that means:

• The doctor received training from an approved residency program. An approved program has to meet established educational standards.
• The doctor has passed a comprehensive test.
• The doctor has met the other requirements set by the board that gives the test.
  
  
  

Breast Cancer Screening - The percent of the Primary Care Provider's (PCP) Priority Health female members ages 50-69 years old who have obtained a mammography screening within two years. Mammography screening can detect breast cancer early.

Cervical Cancer Screening - The percent of the Primary Care Provider's (PCP) Priority Health female members ages 18-64 years old who obtained a Pap test within three years. Pap tests can detect 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.

Depression - The percent of Priority Health members with depression in the Primary Care Provider's (PCP) risk group that received appropriate follow-up care after being prescribed antidepressant medications. The appropriate follow-up care for patients being with antidepressant medication 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 properly 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.

Fellowship - A doctor who has finished medical school, residency and who is training for a very specialized area of medicine.

Group Practice - The name of the office where the practitioner sees patients. There may be more than one practitioner in each office.

Hospital Affiliation - All hospitals where the practitioner has affiliations. The primary hospital affiliation (indicated by the *) is the hospital where a practitioner will usually admit a patient or send a patient for services.

Internship - A one-year period of training immediately following medical school.

Medicare Participant - Practitioners who accept Medicare payment will see patients who have Medicare coverage. This is important because patients with Medicare coverage may pay more to see physicians who do not participate with Medicare.

Other Languages Spoken In The Office - 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.

Other Medical Interests - Other areas of medicine that the practitioner has interest and/or knowledge. This information is supplied by the practitioner.

*Not all treatments listed in medical interests are covered benefits by Priority Health. Refer to your Certificate of Coverage for specific benefit information.

Overall Satisfaction - The percentage of Priority Health members, in the Primary Care Provider's (PCP) practice group, who responded "excellent" or "very good" in 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.

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 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.

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.

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.

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.

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 healthcare 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.