UnitedHealth Premium SM

Size: px
Start display at page:

Download "UnitedHealth Premium SM"

Transcription

1 Physician s Commonly Asked Questions June 17, 2005 UnitedHealth Premium SM Designation Program 1. What is the UnitedHealth Premium designation program? The UnitedHealth Premium designation programs recognizes specialty and primary care physicians and cardiac facilities that meet or exceed certain evidence and consensus based quality standards and efficiency standards. The program is an information tool for UnitedHealthcare enrollees to use that helps them to make informed decisions about their health care. This program is an extension of our long standing commitment to supporting evidence-based medicine and the use of data to identify opportunities for improvement such as physician data sharing (PDS) and the distribution of Clinical Evidence. 2. Why does the program exist? UnitedHealthcare believes that health care in America can and must work better. Variation in care delivery is a recognized issue. Clinical societies and consumer quality coalitions are addressing this issue by developing evidence-based medical guidelines. UnitedHealthcare has taken this idea one step further to create the UnitedHealth Premium designation program. This innovative program is designed to support adherence to evidence based practice standards along the continuum of care, promoting affordability and quality for our customers and their employees. Using evidence-based medical guidelines, nationally accepted clinical standards and expert independent physician advice, we use evaluate UnitedHealthcare claims data and survey answers to evaluate network physicians and hospitals against critical sets of quality and efficiency criteria. 3. How will I know if I am designated? All physicians who practice in one of the eligible medical specialties will receive communication advising of their designation status. 4. Do I have to be board certified to be designated? Yes, board certification or board eligible is one of the requirements in order to receive the designation. 5. What are the benefits of the UnitedHealth Premium designation program? UnitedHealthcare promotes physicians and facilities who meet either the quality only or quality and efficiency criteria to customers and to their employees. As a result, there is potential that designated physicians will see an increase in the volume of patients accessing their practice. Physicians also have access to evidence based information and peer-to-peer comparison data shared by UnitedHealthcare as part of this designation program. Eligible designated physicians performing at the highest levels may also participate in Practice Rewards, a limited pilot program in 2005 that provides physicians with enhanced reimbursement as part of the designation program. 6. What if I am part of a group practice and only part of the group receives the designation? Currently, designation is only available at the individual physician level. However, in the fall of 2005, group designation will become available for eligible groups and the details will be shared at that time. Copyright 2005 United HealthCare Services, Inc. All Rights Reserved.

2 7. What is the designation methodology? Briefly, the designation criteria are based on nationally recognized and established evidence and consensusbased performance measurements. In August, 2005, look for the detailed specifics regarding the methodology at the physician web site online at 8. Who can I talk to at UnitedHealthcare about the UnitedHealth Premium designation program? UnitedHealthcare has made information regarding this program readily available to physicians and facilities. Detailed information can be found at the physician web site, on the consumer web site of myuhc.com as well as the communications sent by UnitedHealthcare providing physicians with additional contact information. Physicians and facilities may also contact the toll-free number of prior to July 15 th. After July 15, 2005, physicians and facilities can contact Can I appeal my non-designated status with UnitedHealthcare? Yes, you can ask for reconsideration of your designated status. While we will review your designation status and the underlying information specific to your situation, we will not alter the program s methodology. Requests for reconsideration will be considered when a physician can demonstrate that UnitedHealthcare claims data does not accurately represent care provided to the enrollee or if the physician can demonstrate claims data inconsistency that impacts the designation analysis. Physicians may initiate this reconsideration process through written request sent to UnitedHealthcare Physician Recognition Programs Mail Stop MN012-S117, 5901 Lincoln Drive, Edina, MN or by sending an to 10. How often will designation take place, and when is the next designation? The UnitedHealth Premium designation is an annual process and occurs during the summer of each calendar year. Cardiac facilities must apply for the designations and are re-designated annually. Oncologists must apply for the designation and are not required to complete an annual questionnaire. All other eligible specialties do not require an application. 11. How can the designation program really measure my quality of practice? Quality is evaluated based on disease and specialty specific criteria. The quality benchmarks are based on scientifically valid standards, tied to clinical processes and evidence and consensus based rules that meet national guidelines. The UnitedHealth Premium quality designations incorporate the recognition of primary care physicians under the NCQA diabetes and heart/stroke physician recognition programs and the recently released Ambulatory care Quality Alliance (AQA) consensus measurements. Physicians who meet the quality benchmarks receive the UnitedHealth Premium quality designation. 12. What does the confidence interval mean? For specialties using claims analysis methodology, we evaluate claims data for your practice using UnitedHealthcare enrollee claims. Using your actual data, statistical confidence intervals are constructed based on your sample size to determine, with 95% confidence, the probable range of your quality and/or efficiency scores. These intervals are then applied against your local geographic area threshold. Due to the level of confidence intervals used, we are 95% confident that the designated physicians who meet or exceed the quality or efficiency measurements are better than the local geographic area thresholds. 13. Why isn t quality the primary measurement over efficiency? Quality is considered the primary measurement, demonstrating our commitment to evidence-based practice. The quality designation is separated from the efficiency designation. Physicians must first meet the quality benchmarks in order to proceed to the efficiency analysis. Physicians who meet the quality benchmarks will receive the quality designation regardless of their efficiency analysis. June 17, 2005 Page 2 of 7

3 14. I am in a specialty excluded from the UnitedHealth Premium Designation program; why is that? At this time, some medical specialties do not have established evidence-based guidelines for quality performance measures available for use in the program. Specialties for which there are no quality criteria are not evaluated for either quality or efficiency. The specialties that are currently excluded are: Colon Rectal Surgery Dermatology Gastroenterology General Surgery Hematology Neonatology Nuclear Medicine OB/Gyn Ophthalmology Otolaryngology Pediatrics Plastic Surgery Rehabilitation Medicine Therapeutic Radiology Urology Vascular Surgery 15. When will criteria be available for the excluded specialties? For many of the listed excluded specialties, we are working to incorporate evidence-based guidelines. In 2006, many of these specialties will have evidence-based guidelines available, and at that time will be eligible for participation in the designation program. Other specialties are continuing to develop evidence-based criteria that should be available in the next year or two. 16. Isn t this a way to tier your network for economic reasons? No, it is in response to our clients and enrollees request for information. The designations are one tool to assist consumers in making informed decisions about their healthcare. It is important to note that UnitedHealth Premium is not a separate network or a network within a network. All UnitedHealthcare enrollees have access to the broad national UnitedHealthcare network of physician and hospital participants regardless of their designation status. Physicians must meet the quality benchmarks in order to proceed to the efficiency analysis. Physicians who meet the quality benchmarks will receive the quality designation regardless of their efficiency analysis. 17. Why is the NCQA recognition program incorporated into the UnitedHealth Premium program? UnitedHealthcare is the first health care company licensee of Bridges to Excellence (BTE). BTE is an employer sponsored pay-for-performance program that utilizes NCQA physician recognition programs to drive advances in the quality of care and reduce waste and inefficiencies through accountability and financial incentives. Primary Care physicians and endocrinologists with recognition through the NCQA Diabetes Recognition program will meet the UnitedHealth Premium quality criteria. Primary Care physicians with recognition through the NCQA Heart/Stroke program will meet the UnitedHealth Premium quality criteria. This provides physicians with an alternate way to receive the UnitedHealth Premium designation. June 17, 2005 Page 3 of 7

4 18. How can consumers determine who is designated through the UnitedHealth Premium program? UnitedHealthcare identifies designated physicians and cardiac facilities in both online and print provider directories. UnitedHealth Premium designations will be identified as the following: Quality Only Quality and Efficiency Not Rated 19. Am I expected to refer patients to designated physicians, if available? We believe the UnitedHealth Premium designations can help inform both consumers and physicians. We would encourage you to consider the information in your referral decisions. Some of your patients may have health plan benefit designs that provide incentives for them to receive care from designated physicians. Your participation agreement, however, requires you to refer to and/or utilize network physicians and facilities. 20. What if I don t have enough UnitedHealthcare claims to be designated? The adoption of the confidence interval methodology allows us the opportunity to consider physicians for designation who have a lower volume of UnitedHealthcare claims. Primary Care physicians and endocrinologists with recognition through the NCQA Diabetes Recognition program will meet the UnitedHealth Premium quality criteria. Primary Care physicians with recognition through the NCQA Heart/Stroke program will be deemed to have met the UnitedHealth Premium quality criteria. This provides Primary Care physicians and endocrinologists with a low volume of UnitedHealthcare claims an alternate way to receive the UnitedHealth Premium designation. The future introduction of group designation is another method to aggregate data among your partners to increase the volume of UnitedHealthcare claims data. 21. Can I be designated by other methods than claims analysis? Yes. Primary Care physicians and endocrinologists with recognition through the NCQA Diabetes Recognition program will meet the UnitedHealth Premium quality criteria. Primary Care physicians with recognition through the NCQA Heart/Stroke program will meet the UnitedHealth Premium quality criteria. 22. What if my fee schedule is high, causing me not to meet the efficiency criteria? The efficiency analysis is based on total cost, a combination of resource utilization and on unit cost. Even if your fee schedule was high, if your UnitedHealthcare claims demonstrate efficient use of medical resources, a lack of re-do procedures and lack of complication-related expenses, you could receive the efficiency designation. 23. Will you designate Nurse Practitioners and Physician Assistants in the UnitedHealth Premium program? No, the designation program is for medical doctors and doctors of osteopathy who possess an unrestricted medical license. June 17, 2005 Page 4 of 7

5 24. Can having a Nurse Practitioner or Physician Assistant in my practice play a part in my designation? Yes, if they are billing under your medical tax identification number (TIN), they are included in your UnitedHealthcare claims analysis for quality and efficiency. 25. If I do not become designated in 2 or 3 years, could I be terminated from the UnitedHealthcare network? Not as a result of the lack of designation. As long as you remain a credentialed UnitedHealthcare network participant, you can continue to see UnitedHealthcare enrollees regardless of your designated status. 26. If I am not designated, will this affect my future fee schedule? All UnitedHealthcare network participants are paid per the terms of their current contract regardless of the designations status. However, designated physicians practicing at the highest levels may be eligible to participate in Practice Rewards, where available, which does offer a higher reimbursement. 27. Will I receive a financial reward if I receive the UnitedHealth Premium designation? Designated physicians combined with appropriate use of clinical and administrative resources may be eligible for rewards through fee schedule enhancements offered by Practice Rewards, where available. 28. Will not being a designated physician effect my relationship with CMS or any other managed care organization? No, our designation program should not affect your relationship with CMS or any other managed care organization. 29. Will hospitals have access to my designation status? All physicians who receive the UnitedHealth Premium designation will be identified in online and printed physician directories. UnitedHealthcare s communication around designation is focused on consumers and physicians. 30. Could my designation status affect my hospital privileges? No, the program was developed in response to our customers desire to apply an objective quality and affordability assessment to our network while preserving choice and access for their enrollees. 31. What is the date range used for the claims analysis? Claims submitted to UnitedHealthcare for calendar year 2003 and paid through 2004 are used in the UnitedHealth Premium designation evaluation. 32. I am an orthopedic physician and I previously completed a survey to participate in this program. Will I have to complete a survey every year to maintain my designation status? Completing a survey upfront is no longer a participation criterion in order to be designated as a UnitedHealth Premium orthopedic physician. Musculoskeletal physicians who are designated will have an option to voluntarily complete a survey which will be used to identify individual information such as sub-specialty focus (e.g., foot/ankle). Physicians who complete the survey will have their subspecialty focus identified on the consumer website. Physicians who do not complete the survey will be identified to consumers as general orthopedic. 33. Are claims taken into consideration when evaluating oncology physicians for designation? No, claims are not evaluated at this time for oncology designation. Claims do not include information regarding stage of disease, whether the disease is localized or metastasized or if the disease is a new diagnosis or a reoccurrence. Therefore, oncology and hematology physicians who provide adult oncology June 17, 2005 Page 5 of 7

6 services and complete the survey will only be designated for quality until such time that quality and/or efficiency claims criteria can be determined. 34. I am an oncologist who practices at a center that is contracted with Cancer Resource Services. Is this the same as being designated for UnitedHealth Premium? UnitedHealthcare has two oncology programs. The is a designation program for physicians that meet quality criteria. Cancer Resource Services is a network of cancer programs that focuses on the treatment of uncommon and complex cancers. These two programs complement each other. Physicians need to complete the questionnaire to be eligible for designation with the UnitedHealth Premium program regardless of their participation status with a Cancer Resource Services facility. 35. I received a packet of information inviting me to complete an oncology survey for participation. Do I need to complete this survey? All UnitedHealthcare network oncology and hematology participants were mailed an oncology packet. The packet did include a questionnaire that needs to be completed and returned to UnitedHealthcare in order to be considered for designation with the. Physicians who complete the questionnaire will receive written communication regarding their designation status with UnitedHealth Premium. 36. I didn t receive an oncology packet and would like to complete the questionnaire for possible participation. Who do I contact to request a packet? Physicians may contact customer service at to request an oncology packet. 37. My facility is already designated as a UnitedHealth Premium cardiac care facility. How long is the designation valid? All currently designated UnitedHealth Premium cardiac facilities as well as prospective facilities received a letter requesting that they complete an online RFI for consideration as a designated facility for the new designation year of July 1, 2005 June 30, All RFIs will be reviewed in June with communication in July notifying the hospitals of their designated status. Facilities that are currently designated but fail to complete the RFI will lose their designated status as of June 30, Designations will not be available until Will the patient ID card identify the co-pay to collect from the patient based on the designation status of the physician? UnitedHealthcare enrollee ID cards may not identify co-payment amounts. Any questions regarding the UnitedHealthcare enrollee benefits or financial responsibilities can be directed to the toll-free physician number of or by verifying patient benefits and eligibility by using the physician website of 39. How are procedures, lab work, hospital-based services impacted by the designation? These types of services are not designated. However, since the program uses Episodes of Care to evaluate quality and efficiency, the timing, frequency or cost of these services may have an impact on the quality and/or efficiency designation of a physician. 40. Will the UnitedHealthcare directories reflect the NCQA designation programs for Diabetes or Heart/Stroke? The online directory, myuhc.com, viewed by UnitedHealthcare enrollees will identify the NCQA designations in addition to the UnitedHealth Premium designations. The paper directories will reflect the NCQA designations in the Fall/Winter 2005 release. June 17, 2005 Page 6 of 7

7 41. What is the status of the UnitedHealth Performance program? The UnitedHealth Performance program was a pilot program introduced on behalf of three customers in 13 states that designated physicians who provided medical services for common, chronic conditions. Based on the pilot experience, feedback from physicians, medical and specialty societies, new data sources and national developments in physician quality and efficiency standards, the UnitedHealth Performance program pilot is being closed and no new employer groups will be added. As of July, 2005, the UnitedHealth Premium will be enhanced to encompass the common, chronic conditions along with the more complex conditions of cardiology, musculoskeletal and oncology. The three pilot customers will continue to access the UnitedHealth Performance program. Going forward, only the enhanced UnitedHealth Premium designation program will be available to customers and their employees. 42. I am a physician designated for UnitedHealth Performance. Will I remain designated under this program? Yes, designated physicians will remain designated until the third quarter of At that time, all physicians will be re-evaluated for designation under the UnitedHealth Premium designation program. 43. Where do I call if I have questions regarding my designation status? Physicians can call toll-free to prior to July 15. As of July 15, 2005, physicians can contact the physician self-service toll-free number at Who comprise the Scientific Advisory Boards? The role of Scientific Advisory Board is to provide professional and clinical expertise to UnitedHealthcare. The Board is comprised of independent physicians from academic centers such as the Harvard School of Medicine and The Cleveland Clinic as well as community affiliations. Board members are chosen based on their demonstrated contributions to the medical fields, including local and national leadership experience, clinical expertise, professional or academic appointments and individual accomplishments including research, publications and national awards. June 17, 2005 Page 7 of 7

UnitedHealth Premium Designation Program. Driving informed choices and quality, efficient care

UnitedHealth Premium Designation Program. Driving informed choices and quality, efficient care UnitedHealth Premium Designation Program Driving informed choices and quality, efficient care Today s health care system is fraught with wide variation in medical practices that often result in inconsistent

More information

Physician Practice Acquisitions

Physician Practice Acquisitions Trend Watch: Physician Practice Acquisitions Tracking Which Physician Practices Hospitals are Acquiring Introduction Are hospitals actively acquiring physician practices? If so, which specialties? In this

More information

The Health Plan Role in Health Care Transparency: From Here s Some Data to Empowering The Consumer

The Health Plan Role in Health Care Transparency: From Here s Some Data to Empowering The Consumer The Health Plan Role in Health Care Transparency: From Here s Some Data to Empowering The Consumer Lewis G. Sandy MD RWJ Transparency Summit December 3, 2013 1 Pervasive Variation: Episode Costs and Care

More information

The Evolution of UnitedHealth Premium

The Evolution of UnitedHealth Premium The Evolution of UnitedHealth Premium Power to transform heath care delivery Why We Do What We Do? Achieving the The Triple Aim! The root of the problem in

More information

myhealthcare Cost Estimator Member guide Your personalized online tool that will empower you to make more informed health care decisions.

myhealthcare Cost Estimator Member guide Your personalized online tool that will empower you to make more informed health care decisions. SM myhealthcare Cost Estimator Member guide Your personalized online tool that will empower you to make more informed health care decisions. Say yes to know. Get to know myuhc.com. Get to know myuhc.com,

More information

(A) Information needed to identify and classify the hospital, include the following: (b) The hospital number assigned by the department;

(A) Information needed to identify and classify the hospital, include the following: (b) The hospital number assigned by the department; 3701-59-05 Hospital registration and reporting requirements. Every hospital, public or private, shall, by the first of March of each year, register with and report to the department of health the following

More information

Cigna Care Designation and Physician Quality and Cost-Efficiency Displays 2015 Methodologies Whitepaper

Cigna Care Designation and Physician Quality and Cost-Efficiency Displays 2015 Methodologies Whitepaper Cigna Care Designation and Physician Quality and Cost-Efficiency Displays 2015 Methodologies Whitepaper For Health Care Professionals February 2015 Introduction... 2 Cigna Physician Quality and Cost-Efficiency

More information

Your guide to better health Grow healthy. Live well.

Your guide to better health Grow healthy. Live well. Your guide to better health Grow healthy. Live well. FREDERICK COUNTY PUBLIC SCHOOLS Look Inside Where do I go for health tools and resources? How can I get and stay healthy? What mobile applications are

More information

UnitedHealthcare EDGESM

UnitedHealthcare EDGESM UnitedHealthcare EDGESM 100 percent preventive care coverage and that s just the beginning As a leading health and wellness company, UnitedHealthcare is committed to improving the health care system for

More information

Advance Practice Provider (APP) Compensation Models: Promoting Team Based Care. Wayne M. Hartley, Vice President AMGA Consulting Services

Advance Practice Provider (APP) Compensation Models: Promoting Team Based Care. Wayne M. Hartley, Vice President AMGA Consulting Services Advance Practice Provider (APP) Compensation Models: Promoting Team Based Care Wayne M. Hartley, Vice President AMGA Consulting Services 1 Presentation Overview AMGA Survey Overview and Demographics APP

More information

Compensation 2013: Evolving Models, Emerging Approaches

Compensation 2013: Evolving Models, Emerging Approaches Compensation 2013: Evolving Models, Emerging Approaches Results from the AMGA 2013 Medical Group Compensation and Financial Survey By Bradley S.J. Vaudrey, M.B.A., CPA, and Sara Loos, CCP Findings from

More information

The Health Care Incentives Improvement Institute 13 Sugar Street Newtown, CT 06470

The Health Care Incentives Improvement Institute 13 Sugar Street Newtown, CT 06470 Clinician Guide: Bridges to Excellence Cardiac Care Recognition Program The Health Care Incentives Improvement Institute 13 Sugar Street Newtown, CT 06470 bteinformation@bridgestoexcellence.org http://www.hci3.org

More information

January 13, 2016. Lois M. Nora MD JD MBA President and CEO American board of Medical Specialties. Dear Dr. Nora,

January 13, 2016. Lois M. Nora MD JD MBA President and CEO American board of Medical Specialties. Dear Dr. Nora, January 13, 2016 Lois M. Nora MD JD MBA President and CEO American board of Medical Specialties Dear Dr. Nora, CMSS is pleased to comment on the proposed ABMS Standards for Focused Expertise. We have uploaded

More information

Training requirements and initial residency period for selected residency programs

Training requirements and initial residency period for selected residency programs A P P E N D I XC Training requirements and initial residency period for selected residency programs A P P E N D I X C Training requirements and initial residency period for selected residency programs

More information

Accountability and Innovation in Care Delivery Models

Accountability and Innovation in Care Delivery Models Accountability and Innovation in Care Delivery Models Lisa McDonnel Senior Vice President, Network Strategy & Innovation, United Healthcare November 6, 2015 Today s discussion topics Vision Our strategic

More information

Mississippi Medicaid Enrollment Application (Ordering/Referring/Prescribing Provider)

Mississippi Medicaid Enrollment Application (Ordering/Referring/Prescribing Provider) This application is for the sole purpose of ordering/referring/prescribing items and services for MS Medicaid beneficiaries. This type of enrollment does not allow MS Medicaid to reimburse the applicant/provider

More information

Provider Network Adequacy Instructions

Provider Network Adequacy Instructions Provider Network Adequacy Instructions Table of Contents Regulatory Overview...1 Creating an Account under the MDH Provider Network Adequacy (PNA) System...2 Provider Network Adequacy Recertification Requirements...2

More information

Participating Accountable Care Organizations (ACOs) that meet quality performance standards will be eligible to receive payments for shared savings.

Participating Accountable Care Organizations (ACOs) that meet quality performance standards will be eligible to receive payments for shared savings. Background Sec. 3022 of the Patient Protection and Affordable Care Act (PPACA) requires the Secretary to establish the Medicare Shared Savings Program by Jan. 1, 2012 Program goals: Promote accountability

More information

Welcome to UnitedHealthcare. Ideally, better health coverage should cost less. In reality, now it can.

Welcome to UnitedHealthcare. Ideally, better health coverage should cost less. In reality, now it can. Welcome to UnitedHealthcare Ideally, better health coverage shold cost less. In reality, now it can. The plan designed with both qality and affordability in mind. Consistent, qality care is vitally important.

More information

Diagnostic Imaging Management

Diagnostic Imaging Management Diagnostic Imaging Management Frequently Asked Questions (FAQ) from Providers Updated August 1, 2013 Program Overview Q1. What is AIM Specialty Health SM (AIM)? A1. AIM Specialty Health SM (AIM) is a leading

More information

Understanding Aexcel. Doctors who meet certain standards for clinical performance and efficiency. What the blue star means for you 38.02.314.

Understanding Aexcel. Doctors who meet certain standards for clinical performance and efficiency. What the blue star means for you 38.02.314. Understanding Aexcel What the blue star means for you Doctors who meet certain standards for clinical performance and efficiency 38.02.314.1 (6/09) Our performance network includes Aexcel-designated doctors

More information

Your guide to UnitedHealthcare

Your guide to UnitedHealthcare Your guide to UnitedHealthcare Face the future with confidence The benefits environment remains challenging. Uncertainty reigns as a wave of new regulation sweeps across the industry. Costs continue to

More information

Rockbridge Underwriting Agency Limited 3700 Buffalo Speedway, Suite 300 Houston, TX 77098 (713) 874-8800 (713) 874-8899 fax

Rockbridge Underwriting Agency Limited 3700 Buffalo Speedway, Suite 300 Houston, TX 77098 (713) 874-8800 (713) 874-8899 fax Rockbridge Underwriting Agency Limited 3700 Buffalo Speedway, Suite 300 Houston, TX 77098 (713) 874-8800 (713) 874-8899 fax Corporate Locum Tenens Underwriting Questionnaire and Application for Professional

More information

AGREEMENT CONCERNING PHYSICIAN PERFORMANCE MEASUREMENT, REPORTING AND TIERING PROGRAMS PURSUANT TO EXECUTIVE LAW SECTION 63, SUBDIVISION 15

AGREEMENT CONCERNING PHYSICIAN PERFORMANCE MEASUREMENT, REPORTING AND TIERING PROGRAMS PURSUANT TO EXECUTIVE LAW SECTION 63, SUBDIVISION 15 ATTORNEY GENERAL OF THE STATE OF NEW YORK In the Matter of CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND CIGNA HEALTHCARE OF NEW YORK, INC. AGREEMENT CONCERNING PHYSICIAN PERFORMANCE MEASUREMENT, REPORTING

More information

The AQA Alliance. July 19, 2007 Jon White, MD Health IT Director, AHRQ NCVHS Secondary Uses of Health Data Ad Hoc Workgroup

The AQA Alliance. July 19, 2007 Jon White, MD Health IT Director, AHRQ NCVHS Secondary Uses of Health Data Ad Hoc Workgroup The AQA Alliance July 19, 2007 Jon White, MD Health IT Director, AHRQ NCVHS Secondary Uses of Health Data Ad Hoc Workgroup Beginnings September 2004 American Academy of Family Physicians (AAFP) American

More information

Premium Designation Questions

Premium Designation Questions Premium Designation Questions Q. Are all doctors going to be Tier 1? A. All Primary Care Providers Family Practice, Internal Medicine, OB GYN, and Pediatrics will be considered at the Tier 1 Level for

More information

Your UnitedHealthcare Definity SM Health Reimbursement Account

Your UnitedHealthcare Definity SM Health Reimbursement Account Your UnitedHealthcare Definity SM Health Reimbursement Account At UnitedHealthcare, we believe that health insurance is much more than just coverage when you re ill or injured. When you are sick, your

More information

Banner Health Network Pioneer ACO - Physician Toolkit

Banner Health Network Pioneer ACO - Physician Toolkit & The Banner Health Network, an AIP and Banner Health partnership, present the Banner Health Network Pioneer ACO - Physician Toolkit This BHN Pioneer ACO Physician Toolkit has been developed to provide

More information

What Does it Mean When Patients Choose Wisely? David Ansley Senior Analyst, Health Product Development Consumer Reports

What Does it Mean When Patients Choose Wisely? David Ansley Senior Analyst, Health Product Development Consumer Reports What Does it Mean When Patients Choose Wisely? David Ansley Senior Analyst, Health Product Development Consumer Reports People are realizing that more medicine is not necessarily better. And that we re

More information

League of Women Voters. November 20, 2012

League of Women Voters. November 20, 2012 League of Women Voters November 20, 2012 Palo Alto Medical Foundation Multi-Specialty Medical Group for past 82 years. Outpatient Medical Centers not a hospital Community based, not-for-profit Physician-led

More information

The Health Care Incentives Improvement Institute 13 Sugar Street Newtown, CT 06470

The Health Care Incentives Improvement Institute 13 Sugar Street Newtown, CT 06470 Clinician Guide: Bridges to Excellence Congestive Heart Failure Care Recognition Program The Health Care Incentives Improvement Institute 13 Sugar Street Newtown, CT 06470 bteinformation@bridgestoexcellence.org

More information

Compare your plan options

Compare your plan options SMALL BUSINESS GROUP Compare your plan options 2014 plans for businesses with 1 50 employees I SMALL BUSINESS GROUP Group Health plans offer value, choice, and more A well-run business takes a lot of time,

More information

VNS CHOICE: Managing Complex Care Needs for the Frail Elderly of New York City. Roberta Brill Vice President, VNS Health Plans

VNS CHOICE: Managing Complex Care Needs for the Frail Elderly of New York City. Roberta Brill Vice President, VNS Health Plans VNS CHOICE: Managing Complex Care Needs for the Frail Elderly of New York City Roberta Brill Vice President, VNS Health Plans VNS CHOICE Organization Subsidiary of the Visiting Nurse Service of New York

More information

Compare your plan options

Compare your plan options SMALL BUSINESS GROUP 2015 Compare your plan options Plans for businesses with 1 50 employees 1 SMALL BUSINESS GROUP Value, choice, and quality the Group Health difference Your job is running a business.

More information

Frequently Asked Questions (FAQs)

Frequently Asked Questions (FAQs) Registration and Enrollment... 2 Provider Registration- First Year Applicants... 2 Provider Registration- Returning Applicants... 2 Provider Eligibility... 3 Eligibility Eligible Professionals... 3 Eligibility

More information

Survey PRACTICE AND COMPENSATION EXPECTATIONS FOR PHYSICIAN ASSISTANTS. 800.780.3500 mdainc.com

Survey PRACTICE AND COMPENSATION EXPECTATIONS FOR PHYSICIAN ASSISTANTS. 800.780.3500 mdainc.com Survey PRACTICE AND COMPENSATION EXPECTATIONS FOR PHYSICIAN ASSISTANTS 800.780.3500 mdainc.com Overview OBJECTIVE The objective of this survey was to collect and quantify practice and compensation expectations

More information

Compare your plan options

Compare your plan options FEDERAL EMPLOYEES RATES & BENEFITS 2016 Compare your plan options Choose the plan that fits you and your family Why choose Group Health? There are lots of reasons to choose Group Health, and for Federal

More information

Advance Notification/Prior Authorization

Advance Notification/Prior Authorization Advance Notification/Prior Authorization Physician Frequently Asked Questions Overview The objective of our medical management program is to improve the appropriateness and affordability of care through

More information

Managing Images Across the Enterprise. Kim Garriott & Louis Lannum July 30, 2015

Managing Images Across the Enterprise. Kim Garriott & Louis Lannum July 30, 2015 Managing Images Across the Enterprise Kim Garriott & Louis Lannum July 30, 2015 Objectives Summarize what an enterprise imaging strategy is and address key components Discuss the role of Clinical Engineering

More information

More than a score: working together to achieve better health outcomes while meeting HEDIS measures

More than a score: working together to achieve better health outcomes while meeting HEDIS measures NEVADA ProviderNews Vol. 3 2014 More than a score: working together to achieve better health outcomes while meeting HEDIS measures We know you ve heard of Healthcare Effectiveness Data and Information

More information

A VISION TO TRANSFORM U.S. HEALTH CARE. The programs to make it a reality.

A VISION TO TRANSFORM U.S. HEALTH CARE. The programs to make it a reality. A VISION TO TRANSFORM U.S. HEALTH CARE. The programs to make it a reality. HCI 3 IMPROVING HEALTH CARE QUALITY AND VALUE with evidence-based incentive programs and a fair and powerful model for payment

More information

Putting Reliable Health Care Performance Measurement Systems into Practice

Putting Reliable Health Care Performance Measurement Systems into Practice An NCQA Issue Brief 2000 L Street, NW Washington, DC 20036 888-275-7585 www.ncqa.org Putting Reliable Health Care Performance Measurement Systems into Practice By Joachim Roski, PhD MPH; Vice President,

More information

2013 Physician Inpatient/ Outpatient Revenue Survey

2013 Physician Inpatient/ Outpatient Revenue Survey Physician Inpatient/ Outpatient Revenue Survey A survey showing net annual inpatient and outpatient revenue generated by physicians in various specialties on behalf of their affiliated hospitals Merritt

More information

UnitedHealth Premium Physician Designation Program Detailed Methodology

UnitedHealth Premium Physician Designation Program Detailed Methodology UnitedHealth Premium Physician Designation Program Detailed Methodology Resources Phone: Toll-free, 866-270-5588 Website: UnitedHealthcareOnline.com > UnitedHealth Premium > Premium Methodology Table of

More information

Prospective Attribution as a Single-Step Assignment Process

Prospective Attribution as a Single-Step Assignment Process Marilyn Tavenner, Administrator Centers for Medicare & Medicaid Services Department of Health and Human Services Attention: CMS 1461 P P.O. Box 8013 Baltimore, MD 21244 8013 Dear Administrator Tavenner:

More information

Pediatric Alliance: A New Solution Built on Familiar Values. Empowering physicians with an innovative pediatric Accountable Care Organization

Pediatric Alliance: A New Solution Built on Familiar Values. Empowering physicians with an innovative pediatric Accountable Care Organization Pediatric Alliance: A New Solution Built on Familiar Values Empowering physicians with an innovative pediatric Accountable Care Organization BEYOND THE TRADITIONAL MODEL OF CARE Children s Health SM Pediatric

More information

Choice Plus Plan. UnitedHealthcare. with a HEALTH REIMBURSEMENT ACCOUNT. Medical. You can choose any doctor or hospital you want.

Choice Plus Plan. UnitedHealthcare. with a HEALTH REIMBURSEMENT ACCOUNT. Medical. You can choose any doctor or hospital you want. Medical UnitedHealthcare Choice Plus Plan with a HEALTH REIMBURSEMENT ACCOUNT welcometouhc.com Find a network doctor. Choose with confidence. Our UnitedHealth Premium designation program recognizes physicians

More information

The Impact of Changing Federal Policies on Physician Reimbursement

The Impact of Changing Federal Policies on Physician Reimbursement The Impact of Changing Federal Policies on Physician Reimbursement Peter Margolis, MD, AGAF Chair elect, AGA Regulatory Work Group AGA Institute Practice Management & Economics Committee University Gastroenterology

More information

UnitedHealthcare. with a HEALTH REIMBURSEMENT ACCOUNT (HRA) A national network to help lower your costs

UnitedHealthcare. with a HEALTH REIMBURSEMENT ACCOUNT (HRA) A national network to help lower your costs Medical UnitedHealthcare Choice Plus Plan with a HEALTH REIMBURSEMENT ACCOUNT (HRA) Visit welcometouhc.com Find a network doctor. Estimate the cost of the plan. Find a network pharmacy. See recommended

More information

Exhibit 4. Provider Network

Exhibit 4. Provider Network Exhibit 4 Provider Network Provider Contract Requirements ICS must develop, implement, and maintain a comprehensive provider network that assures access to primary and specialty health related care that

More information

CHAPTER 7: UTILIZATION MANAGEMENT

CHAPTER 7: UTILIZATION MANAGEMENT OVERVIEW The Plan s Utilization Management (UM) program is collaboration with providers to promote and document the appropriate use of health care resources. The program reflects the most current utilization

More information

Accountable Care Organizations New Healthcare Opportunities for Employers

Accountable Care Organizations New Healthcare Opportunities for Employers Accountable Care Organizations New Healthcare Opportunities for Employers The ACO and Employer Opportunities Since the passage of the Patient Protection and Affordable Care Act (PPACA) in 2009, the marketplace

More information

Special Needs Plan Provider Education

Special Needs Plan Provider Education Special Needs Plan Provider Education Reviewed September 2014 Learning Goals What is a Special Needs Plan (SNPs) What differentiates a SNP from other MA plans What SNPs are offered by Freedom Health and

More information

Physical & Occupational Therapy Authorization FAQs

Physical & Occupational Therapy Authorization FAQs Physical & Occupational Therapy Authorization FAQs 1. What are the authorization requirements for the UM program? The utilization management program requires providers to obtain authorization after the

More information

Chapter 4 Health Care Management Unit 1: Care Management

Chapter 4 Health Care Management Unit 1: Care Management Chapter 4 Health Care Unit 1: Care In This Unit Topic See Page Unit 1: Care Care 2 6 Emergency 7 4.1 Care Healthcare Healthcare (HMS), Highmark Blue Shield s medical management division, is responsible

More information

UnitedHealth Premium gets an update

UnitedHealth Premium gets an update Page 1 of 5 Login to myuhc.com Print all articles JANUARY 2014 UnitedHealth Premium gets an update Want to estimate your health care costs? Weight loss: Are you ready to get serious? Healthy recipe: Popcorn

More information

Health care with a difference. Montgomery County Public Schools Employee and Retiree Health Benefits Program 2011 Group Policy Number 704567

Health care with a difference. Montgomery County Public Schools Employee and Retiree Health Benefits Program 2011 Group Policy Number 704567 Health care with a difference. Montgomery County Public Schools Employee and Retiree Health Benefits Program 2011 Group Policy Number 704567 One of a kind. We re delivering health care from a fresh -

More information

METROWEST MEDICAL CENTER

METROWEST MEDICAL CENTER (508) 650-7000 Framingham Union METROWEST MEDICAL CENTER 115 Lincoln Street (508) 383-1000 24-hour Emergency Department Care Community Healthcare Provider This healthcare network encompasses the entirety

More information

RE: CMS-0033-P, Medicare and Medicaid Programs; Electronic Health Record Incentive Program; Proposed Rule (Vol. 75, No. 8), January 13, 2010

RE: CMS-0033-P, Medicare and Medicaid Programs; Electronic Health Record Incentive Program; Proposed Rule (Vol. 75, No. 8), January 13, 2010 The Honorable Kathleen Sebelius Secretary Department of Health and Human Services 200 Independence Avenue, SW Washington, DC 20201 RE: CMS-0033-P, Medicare and Medicaid Programs; Electronic Health Record

More information

UnitedHealthcare Insurance Company Written Plan Description

UnitedHealthcare Insurance Company Written Plan Description UnitedHealthcare Insurance Company Written Plan Description [CHOICE][EXCLUSIVE PROVIDER PLAN] This coverage is provided by UnitedHealthcare Insurance Company (UnitedHealthcare). This coverage provides

More information

Teaching Physician Billing Compliance. Effective Date: March 27, 2012. Office of Origin: UCSF Clinical Enterprise Compliance Program. I.

Teaching Physician Billing Compliance. Effective Date: March 27, 2012. Office of Origin: UCSF Clinical Enterprise Compliance Program. I. Teaching Physician Billing Compliance Effective Date: March 27, 2012 Office of Origin: UCSF Clinical Enterprise Compliance Program I. Purpose These Policies and Procedures are intended to clarify the Medicare

More information

Quality and Performance Improvement Program Description 2016

Quality and Performance Improvement Program Description 2016 Quality and Performance Improvement Program Description 2016 Introduction and Purpose Contra Costa Health Plan (CCHP) is a federally qualified, state licensed, county sponsored Health Maintenance Organization

More information

UnitedHealthcare Choice Plus. United HealthCare Insurance Company. Certificate of Coverage

UnitedHealthcare Choice Plus. United HealthCare Insurance Company. Certificate of Coverage UnitedHealthcare Choice Plus United HealthCare Insurance Company Certificate of Coverage For Westminster College Enrolling Group Number: 715916 Effective Date: January 1, 2009 Offered and Underwritten

More information

Attachment A UPMC PRACTICE SOLUTIONS - MEDCHART & MEDLINK PRACTICE ASSESSMENT www.medchart.info.com 1-866-648-8483

Attachment A UPMC PRACTICE SOLUTIONS - MEDCHART & MEDLINK PRACTICE ASSESSMENT www.medchart.info.com 1-866-648-8483 Practice Name: Specialty: Main Contact Office Phone: Office Manager Name: Main Contact Office Fax: Office Manager e-mail: Office Manager cell: Number of Providers: Physician Name: Credentials: Specialty:

More information

MGMA PROVIDER COMPENSATION 2015

MGMA PROVIDER COMPENSATION 2015 Physicians Allergy/Immunology 203 86 Anesthesiology 2,146 120 Anesthesiology: Pain Management 127 59 Cardiology: Electrophysiology 327 126 Cardiology: Invasive 424 148 Cardiology: Invasive-Interventional

More information

Electronic Health Records (EHR) Demonstration Frequently Asked Questions

Electronic Health Records (EHR) Demonstration Frequently Asked Questions Demo Goals / Objectives 1. What is the Electronic Health Records Demonstration, and why are you doing it? The Electronic Health Records Demonstration is a five-year demonstration project that will encourage

More information

INDUSTRY PERSPECTIVES

INDUSTRY PERSPECTIVES INDUSTRY PERSPECTIVES Behavioral Health: Staying ahead of the shortage As the demand for behavioral health professionals increases, facilities should consider what implications this may have on facility

More information

RE: CMS-1416-P, Medicare Program; Medicare Shared Savings Program; Accountable Care Organizations; Proposed Rule

RE: CMS-1416-P, Medicare Program; Medicare Shared Savings Program; Accountable Care Organizations; Proposed Rule Marilynn B. Tavenner Administrator Center for Medicare & Medicaid Services U.S. Department of Health and Human Services Hubert H. Humphrey Building, Room 445-G 200 Independence Avenue, SW Washington, DC

More information

2002 Physician Inpatient/Outpatient Revenue Survey

2002 Physician Inpatient/Outpatient Revenue Survey 2002 Physician Inpatient/Outpatient Revenue Survey INTRODUCTION: Merritt, Hawkins & Associates is a national physician search and consulting firm representing over 2,000 physician search engagements annually.

More information

Grow Healthy. State Health Benefit Plan YOUR 2012 BENEFITS STATE HEALTH BENEFIT PLAN MEMBERS

Grow Healthy. State Health Benefit Plan YOUR 2012 BENEFITS STATE HEALTH BENEFIT PLAN MEMBERS State Health Benefit Plan Grow Healthy Dedicated Service. Useful Tools. Real Solutions. YOUR 2012 BENEFITS STATE HEALTH BENEFIT PLAN MEMBERS Look inside to learn about: Benefit options Health support and

More information

Simple. UnitedHealthcare Plan Benefits. Personal. Empowering. An easy-to-use guide to understanding your UnitedHealthcare benefits offered by Sprint.

Simple. UnitedHealthcare Plan Benefits. Personal. Empowering. An easy-to-use guide to understanding your UnitedHealthcare benefits offered by Sprint. UnitedHealthcare Plan Benefits Simple. Personal. Empowering. An easy-to-use guide to understanding your UnitedHealthcare benefits offered by Sprint. What s Inside: Introduction..........................

More information

MGMA ACA Exchange Implementation Survey Report. May 2014

MGMA ACA Exchange Implementation Survey Report. May 2014 MGMA ACA Exchange Implementation Survey Report May 2014 Overview Medical Group Management Association (MGMA) conducted member research in April 2014 to better understand the impact of the Affordable Care

More information

Disease Management Identifications and Stratification Health Risk Assessment Level 1: Level 2: Level 3: Stratification

Disease Management Identifications and Stratification Health Risk Assessment Level 1: Level 2: Level 3: Stratification Disease Management UnitedHealthcare Disease Management (DM) programs are part of our innovative Care Management Program. Our Disease Management (DM) program is guided by the principles of the UnitedHealthcare

More information

Qs &As on the Increased Medicaid Payment for Primary Care CMS 2370-F

Qs &As on the Increased Medicaid Payment for Primary Care CMS 2370-F Qs &As on the Increased Medicaid Payment for Primary Care CMS 2370-F When will states begin making higher payment for Evaluation and Management services reimbursed fee for service? Effective for dates

More information

Available Disciplines... 4 Family Medicine... 4 Specialty Medicine... 4. Preceptor Searches... 4 Eligibility queue... 4

Available Disciplines... 4 Family Medicine... 4 Specialty Medicine... 4. Preceptor Searches... 4 Eligibility queue... 4 Table of Contents Eligibility Overview... 3 NOSM contact... 3 Entry into Canada... 3 Clerkship definition... 3 International student categories... 3 Continuous application dates... 3 Core rotations...

More information

Capital District Physicians Health Plan, Inc. Nonprofit Health Plan Albany, New York

Capital District Physicians Health Plan, Inc. Nonprofit Health Plan Albany, New York Capital District Physicians Health Plan, Inc. Nonprofit Health Plan Albany, New York Capital District Physicians Health Plan, Inc. (CDPHP ) is featured as a high performer in cardiovascular care, identified

More information

Responsibilities of the Program Coordinator. Presentation Goals. What is a Program Coordinator?

Responsibilities of the Program Coordinator. Presentation Goals. What is a Program Coordinator? Responsibilities of the Program Coordinator New Coordinators Pre-Course 2008 ACGME Annual Educational Conference Grapevine, Texas Norma R. de Yagcier Senior Accreditation Administrator Presentation Goals

More information

Good health happens together

Good health happens together Good health happens together CITY OF BALTIMORE 2016 HEALTH CARE OPTIONS WHAT S INSIDE BENEFITS OVERVIEW WELLNESS RESOURCES ONLINE TOOLS Thank you for considering UnitedHealthcare. We are proud to again

More information

Specialty-specific References for DIOs: Program Director Qualifications ACGME

Specialty-specific References for DIOs: Program Director Qualifications ACGME -specific References for DIOs: Program Director Qualifications ACGME Common Program Requirements are in BOLD Specialty Allergy and Immunology Anesthesiology II.A.3.b) current certification in the specialty

More information

SIMPLICITY. 2015 Your Plan Explained

SIMPLICITY. 2015 Your Plan Explained Hello SIMPLICITY 2015 Your Plan Explained PFIZER UnitedHealthcare Group Medicare Advantage (PPO) Effective January 1, 2015, through December 31, 2015 Group Number: 12367, 12368 Benefit Highlights UnitedHealthcare

More information

REPORT TO THE 2015 LEGISLATURE. Report on Findings from the Hawai i Physician Workforce Assessment Project

REPORT TO THE 2015 LEGISLATURE. Report on Findings from the Hawai i Physician Workforce Assessment Project REPORT TO THE 2015 LEGISLATURE Report on Findings from the Hawai i Physician Workforce Assessment Project Act 18, SSLH 2009 (Section 5), as amended by Act 186, SLH 2012 January 2015 Hawai i Physician Workforce

More information

Riverside Physician Network Utilization Management

Riverside Physician Network Utilization Management Subject: Program Riverside Physician Network Author: Candis Kliewer, RN Department: Product: Commercial, Senior Revised by: Linda McKevitt, RN Approved by: Effective Date January 1997 Revision Date 1/21/15

More information

Eligible Professional s Checklist 2015 Modified Stage 2 Meaningful Use

Eligible Professional s Checklist 2015 Modified Stage 2 Meaningful Use This checklist provides a look into Ohio s Medicaid Provider Incentive Program (MPIP) system for eligible professionals and may be used as a guide to help eligible professionals gather information that

More information

VOLUME 7A, CHAPTER 5: SPECIAL PAY AND BONUSES FOR MEDICAL AND OTHER HEALTH PROFESSIONAL OFFICERS SUMMARY OF MAJOR CHANGES

VOLUME 7A, CHAPTER 5: SPECIAL PAY AND BONUSES FOR MEDICAL AND OTHER HEALTH PROFESSIONAL OFFICERS SUMMARY OF MAJOR CHANGES VOLUME 7A, CHAPTER 5: SPECIAL PAY AND BONUSES FOR MEDICAL AND OTHER HEALTH PROFESSIONAL OFFICERS SUMMARY OF MAJOR CHANGES All changes are denoted by blue font. Substantive revisions are denoted by an asterisk

More information

Introducing UnitedHealthcare North Shore-LIJ Advantage When doctors connect, everyone benefits

Introducing UnitedHealthcare North Shore-LIJ Advantage When doctors connect, everyone benefits Introducing UnitedHealthcare North Shore-LIJ Advantage When doctors connect, everyone benefits For New York fully insured employers with 2-50 enrolled employees (Queens, Nassau, Suffolk counties) UnitedHealthcare

More information

Mission Possible: Implementing econsult in the Los Angeles County Healthcare System

Mission Possible: Implementing econsult in the Los Angeles County Healthcare System SEPTEMBER 2013 Mission Possible: Implementing econsult in the Los Angeles County Healthcare System INTRODUCTION With the full implementation of the Affordable Care Act fast approaching, providers are getting

More information

ALL PHYSICIANS are to furnish their board certification and current hospital privileges, if applicable. PLEASE LIST:

ALL PHYSICIANS are to furnish their board certification and current hospital privileges, if applicable. PLEASE LIST: PHYSICIAN CONTRACT APPLICATION (INDEPENDENT MEDICAL REVIEWER) For the Department of Industrial Relations Division of Workers Compensation P.O. Box 71010 Oakland, CA 94612 FOR OFFICE USE ONLY NO.: INPUT

More information

2012 Physician Specialty Data Book. Center for Workforce Studies. November 2012. Association of American Medical Colleges

2012 Physician Specialty Data Book. Center for Workforce Studies. November 2012. Association of American Medical Colleges Center for Workforce Studies November 2012 Association of American Medical Colleges Table of Contents Introduction... 1 Acknowledgments... 1 Key Findings... 2 Key Definitions... 3 Commonly Used Acronyms...

More information

211 CMR: DIVISION OF INSURANCE 211 CMR 52.00: MANAGED CARE CONSUMER PROTECTIONS AND ACCREDITATION OF CARRIERS

211 CMR: DIVISION OF INSURANCE 211 CMR 52.00: MANAGED CARE CONSUMER PROTECTIONS AND ACCREDITATION OF CARRIERS 211 CMR: DIVISION OF INSURANCE 211 CMR 52.00: MANAGED CARE CONSUMER PROTECTIONS AND ACCREDITATION OF CARRIERS Section 52.01: Authority 52.02: Applicability 52.03: Definitions 52.04: Accreditation of Carriers

More information

Question & Answer Guide. (Effective July 1, 2014)

Question & Answer Guide. (Effective July 1, 2014) Joint Commission Primary Care Medical Home (PCMH) Certification for Accredited Ambulatory Health Care Organizations Question & Answer Guide (Effective July 1, 2014) A. ELIGIBILITY/DECISION-RELATED Question:

More information

The University of Queensland School of Medicine Ochsner Clinical School

The University of Queensland School of Medicine Ochsner Clinical School The University of Queensland School of Medicine Ochsner Clinical School UQ School of Medicine, Brisbane A New Global Medical Education Paradigm The University of Queensland School of Medicine Ochsner Clinical

More information

In addition to the completed application, we will need the following:

In addition to the completed application, we will need the following: Thank you for your interest in becoming a Consociate Care Network Provider. In addition to the completed application, we will need the following: Copy of CV Copy of medical license Copy of DEA license

More information

MODERNIZE YOUR HEALTH PLAN BY INCREASING INDIVIDUAL HEALTH OWNERSHIP

MODERNIZE YOUR HEALTH PLAN BY INCREASING INDIVIDUAL HEALTH OWNERSHIP MODERNIZE YOUR HEALTH PLAN BY INCREASING INDIVIDUAL HEALTH OWNERSHIP Lancaster County Business Group on Health, Forecast Breakfast, September 25, 2014 Impact of ACA & Pharmacy on UHC Clients Financial:

More information

Economic Credentialing by Insurance Companies

Economic Credentialing by Insurance Companies Economic Credentialing by Insurance Companies The Impact of Cost Profiling on Your Practice and Reputation The Accreditation Council for Graduate Medical Education (ACGME), United Council for Neurologic

More information

December 2014. Federal Employees Health Benefits (FEHB) Program Report on Health Information Technology (HIT) and Transparency

December 2014. Federal Employees Health Benefits (FEHB) Program Report on Health Information Technology (HIT) and Transparency December 2014 Federal Employees Health Benefits (FEHB) Program Report on Health Information Technology (HIT) and Transparency I. Background Federal Employees Health Benefits (FEHB) Program Report on Health

More information

1. To be eligible for Non-Physician Health Care Provider Board Certified Pay (NPBCP), a Nurse Corps officer must:

1. To be eligible for Non-Physician Health Care Provider Board Certified Pay (NPBCP), a Nurse Corps officer must: 1. Chapter 4 of OPNAV 7220.17 is amended by replacing the current section 430 with the following: 430. DEFINITION AND ELIGIBILITY 1. To be eligible for Non-Physician Health Care Provider Board Certified

More information

Blue Care Network Physical & Occupational Therapy Utilization Management Guide Published 11/13/2012

Blue Care Network Physical & Occupational Therapy Utilization Management Guide Published 11/13/2012 Blue Care Network Physical & Occupational Therapy Utilization Management Guide Published 11/13/2012 Landmark Healthcare, Inc., oversees outpatient physical, occupational and speech services for BCN members

More information

DETAILED SUMMARY--MEDCIARE SHARED SAVINGS/ACCOUNTABLE CARE ORGANIZATION (ACO) PROGRAM

DETAILED SUMMARY--MEDCIARE SHARED SAVINGS/ACCOUNTABLE CARE ORGANIZATION (ACO) PROGRAM 1 DETAILED SUMMARY--MEDCIARE SHARED SAVINGS/ACCOUNTABLE CARE ORGANIZATION (ACO) PROGRAM Definition of ACO General Concept An ACO refers to a group of physician and other healthcare providers and suppliers

More information

What do ACO s and Hospitals want from SNF s and CCRC s

What do ACO s and Hospitals want from SNF s and CCRC s What do ACO s and Hospitals want from SNF s and CCRC s Presented to the Institute of Senior Living, April 11, 2013 A Division of Kindred Healthcare 1 Assessing the match: What hospitals and ACO s currently

More information

The Georgia Center for Oncology Research and Education: Background and History. Nancy M. Paris, MS, FACHE

The Georgia Center for Oncology Research and Education: Background and History. Nancy M. Paris, MS, FACHE The Georgia Center for Oncology Research and Education: Background and History Nancy M. Paris, MS, FACHE 2008 The Georgia Center for Oncology Research and Education (Georgia CORE) is a novel collaboration

More information