URAC has awarded Physicians Health Plan accreditation  for both its Commercial HMO/POS combined product lines and Medicaid product line.

URAC evaluates how well a health plan manages all parts of its delivery system -- physicians, hospitals, other providers and administrative services -- in order to continuously improve health care for its members.

During the accreditation process, PHP was measured against rigorous standards in the areas of:

• Customer service and addressing member concerns
  
• Providing high credentialing standards of providers
  
• Responding to member and practitioner issues
  
• Listening to and addressing feedback of new members

For more information visit URAC.org.

 

Background and Objective
PHP’s Quality Improvement Program (QIP) is based on a written description that is reviewed and updated annually by PHP. The written program description provides the integrated framework for all quality improvement activities, and provides overall guidance to the activities of the various standing quality committees. The written QIP description is of sufficient breadth to cover all activities of PHP, both clinical and service oriented.

The objective of the QIP is effective and efficient implementation of the quality improvement process defined as:

• QI Program Structure Development
  
• Measurement
  
• Communication and Coordination
  
• Evaluation
  
• Compliance with External Regulations and Standards

Structure
The QIP encompasses a system-wide approach to continuous quality assessment and improvement. It is integrated into the entire organization through standing committees with cross-functional representation and ad-hoc multidisciplinary teams. The structure is designed to promote integration and accountability towards achievement of the QIP goals. The PHP Board of Directors retains the authority, responsibility and accountability for PHP operations, including but not limited to, the overall business plan and Quality Improvement (QI) and Utilization Management (UM) programs.

You may request more detailed information about the 2012 PHP QI Program by contacting the Quality Management Department at (517) 364-8400.

Quality Improvement Suggestions
Physicians Health Plan supports Continuous Quality Improvement and we continually look for ways to improve our service. Please submit your ideas to:

Physicians Health Plan 
Quality Improvement Team
PO Box 30377
Lansing MI 48909-7877

Send us an E-mail by clicking here and filling out the secure General Inquiry form We will respond to you within 3 business days.

PHP participates in HEDIS® (Healthcare Effectiveness Data and Information Set) reporting. HEDIS® is a set of standardized performance measures designed to ensure that purchasers and consumers have the information they need to reliably compare the performance of managed healthcare plans. It is sponsored, supported and maintained by the National Committee for Quality Assurance (NCQA) an independent, not-for-profit organization committed to evaluating and publicly reporting on the quality of managed care plans.

 

Tips to Help Prevent Medical Errors

Medical errors are one of the nation's leading causes of death and injury. Estimates provided in a recent report by the Institute of Medicine suggest that 44,000 to as many as 98,000* people die in U.S. hospitals and billions of dollars are spent each year as the result of medical errors.

What can you do?
Be involved in your health care. The following tips may help prevent medical errors:

1. Be an active member of your health care team. Work with your doctor or other health care providers to make decisions about your care. You have the right to ask questions and get answers you can understand.
2. Inform your doctor about all medicines you take. This includes prescription and over-the-counter medicine and dietary supplements such as vitamins and herbs.
3. Inform your doctor of any allergies and adverse reactions you have had to medicines.
4. Make sure you can read your doctor's prescription. After you fill your prescription, read the label right away. Make sure it is what your doctor ordered for you. If the prescription label does not appear correct, do not take the medicine until you verify the label information with your doctor or pharmacist.
5. When you are diagnosed with an illness, learn about your treatment options and make sure that you thoroughly investigate these options with your physician.
6. Have complicated procedures performed at hospitals offering the best survival odds, based in part on the number of procedures a particular hospital performs annually. Generally, hospitals and doctors that perform more procedures annually have better outcomes.

What is PHP doing?
PHP is currently working with our urban hospitals to encourage them to install computer physician order entry systems (CPOE) that enable physicians to enter medication orders via computers linked to prescribing-error software. Such systems cut out handwritten errors or flag drug interactions and have been shown to reduce serious prescribing errors in hospitals by more than fifty percent (50%).* In addition, PHP is encouraging urban hospitals with intensive-care units (ICU) to be staffed with doctors who actually have credentials in critical care medicine. When ICUs are staffed with physicians who have credentials in critical care medicine, the risk of patients dying in the ICU have been shown to be reduced by 10%* or more.

By asking questions, learning more and understanding your risks, you may improve the safety of your own health care and that of your family members. Visit The Leapfrog Group website for further information on patient safety and medical error prevention.

*Estimate based on Institute of Medicine study published in December 1999.