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About the Safety and Quality of Your Care

This section of your online member handbook explains:

Does Priority Health track safety or quality ratings for health care services?
Can I find out how my hospital rates for safety?
How do I know that the care I'm getting follows appropriate medical standards?
Is there a way to compare doctors before I choose one?
Can I find out about the quality of care at my hospital?
Is Priority Health addressing fraud or abuse in the health care system?
Is there a way to report someone who is abusing the health care system?

Q: Does Priority Health track safety or quality ratings for health care services?

A: Yes. Our goal is to improve the quality of your health care, and we support activities that will reduce errors. Go to the Safety & Quality section of our site to learn:
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Q: Can I find out how my hospital rates for safety?

A: Yes. In the Safety & Quality section of this website, you'll see the safety scores of Priority Health-participating hospitals that are based on national safety guidelines tracked by the Michigan Safety & Quality Coalition. You'll learn how the guidelines were established and how to find ratings on any hospital that reports its scores.

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Q: How does Priority Health decide what care and services to approve?

A: Here are some of the ways we make sure that you're getting safe and effective treatment that's right for you:
  • We track care and services you've received.
  • Our chief medical officer and physician committees research and review the safety and effectiveness of new technologies before deciding whether to cover them or not.
  • We make decisions about your health care based only on the care and services that a) are right for you and b) follow appropriate medical standards.
We do not:
  • Restrict doctors from talking about any care option available. We want your doctors and health care team to talk openly with you.
  • Pay doctors or others medical staff to deny coverage or services to you.
  • Offer anyone financial incentives to deny you services.
You can review Priority Health's 2006 Quality Improvement (QI) Workplan and Program Description and our 2005 QI Improvement Evaluation. The Priority Health 2006 Utilization Management (UM) Workplan, Program Description and 2005 UM Evaluation are also available. Call 616 464-8204 for copies.

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Q: Is there a way to compare doctors before I choose one?

A: Yes, you can compare the quality ratings for Primary Care Physicians. Each year, Priority Health measures the quality of the health care that Primary Care Physicians and other primary care providers (PCPs) give to our members. These quality ratings are shown as "apples." Four apples is the highest score for each kind of care measured.

To see a PCP's apple ratings, use the Find a Doctor tool to search for Primary Care Physicians. You can sort the results of your search to show the PCPs with the most apples at the top. Read more about apple ratings in the Physician Quality section of our site.

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Q: Can I find out about the quality of care at my hospital?

A: Yes. You can find ratings of the quality of care that patients receive in the Hospital Quality section of this website. The ratings cover how the hospitals cared for patients with heart attacks, heart failure, pneumonia, or surgery.

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Q: What is Priority Health doing to prevent fraud or abuse in the health care system?

A: As part of our efforts to keep the costs of health care down, Priority Health has a special team that detects and investigates potential fraud and abuse. Read more about what fraud and abuse are and how to prevent them in the Contact Us section of this site.

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Q: Is there a way to report someone who is abusing the health care system?

A: Yes.  If you suspect someone of fraud or abuse, you can help us keep health care costs down by contacting us to report it. Read more on reporting fraud and abuse:

How to Report Fraud & Abuse
Fraud & Abuse FAQ

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Last modified 11/05/07