NCQA Diabetes Recognition Program
The National Committee for Quality Assurance’s (NCQA) Diabetes Physician Recognition Program (http://web.ncqa.org/tabid/139/Default.aspx) co-sponsored by the American Diabetes Association (ADA) is a voluntary program for individual physicians or physician groups that provide care to people with diabetes. Physicians, in all settings, can achieve Recognition by submitting data that demonstrates they are providing quality diabetes care. The Program assesses key measures that were carefully defined and tested for their relationship to improved care for people with diabetes.

For more information you can contact the NCQA Customer Support Department at CustomerSupport@ncqa.org or toll free at (888) 275-7585.

 View a list of Aetna network doctors recognized by the NCQA Diabetes Recognition Program here.

NOTE:

• Please verify that the doctor participates in your plan by clicking on the “Provider Detail” link in DocFind ®
• National Advantage Program (NAP) participating doctors (unless designated as participating in other plans such as HMO) cannot be selected as a primary care physician.
• Services rendered by some doctors may be provided at the out of network level of benefits under your plan.
• Doctors with this symbol may participate with Aetna through an agreement that Aetna has with a vendor. The doctor may not be directly contracted with Aetna, and, consequently, not credentialed by Aetna. Doctors available through these vendors are subject to the credentialing requirements, if any, of the vendor. If you have any questions, contact Aetna Member Services.

NCQA Heart/Stroke Recognition Program
The Heart/Stroke Recognition Program (HSRP) (http://web.ncqa.org/tabid/140/Default.aspx) , a partnership of the American Heart Association (AHA), American Stroke Association (ASA) and the National Committee for Quality Assurance (NCQA), is a voluntary program for individual physicians or physician groups that provide care to patients who have cardiovascular disease or who have had a stroke. Primary Care and specialist physicians in all settings can achieve recognition by submitting data that demonstrates they are providing quality care that help their patients avoid further complications of cardiovascular disease or another stroke.

Measures for the HSRP utilize AHA/ASA’s guidelines and statements on secondary prevention for patients who have cardiovascular disease or another stroke. Program measures are also consistent with NCQA’s Health Plan Employer Data and Information Set (HEDIS®), which helps consumers evaluate and choose health plans.

For more information you can contact the NCQA Customer Support Department at CustomerSupport@ncqa.org or toll free at (888) 275-7585.

 View a list of Aetna network doctors recognized by the Heart/Stroke Recognition Program here.

NOTE:

• Please verify that the doctor participates in your plan by clicking on the “Provider Detail” link in DocFind®
• National Advantage Program (NAP) participating doctors (unless designated as participating in other plans such as HMO) cannot be selected as a primary care physician.
• Services rendered by some doctors may be provided at the out of network level of benefits under your plan.
• Doctors with this symbol may participate with Aetna through an agreement that Aetna has with a vendor. The doctor may not be directly contracted with Aetna, and, consequently, not credentialed by Aetna. Doctors available through these vendors are subject to the credentialing requirements, if any, of the vendor. If you have any questions, contact Aetna Member Services.

NCQA Physician Practice Connections Recognition Program
The National Committee for Quality Assurance’s (NCQA) Physician Practice Connections Recognition Program, http://web.ncqa.org/tabid/141/Default.aspx, recognizes physician practices that use information systematically to enhance the quality of patient care. Physician practices, in all settings, can achieve recognition by submitting documentation that demonstrates they use systems to enhance quality of care. Meeting Physician Practice Connection standards means that practices have connections to information, patients, and other physicians and to evidence based guidelines. The

Program recognizes those practices that:

• Know and use their patients’ histories
• Work with patients over time and not just at office visits
• Follow up with patients and with other providers to get the best results
• Manage populations, not just individuals, using evidence-based care
• Employ electronic tools to prevent medical adverse events.

For more information you can contact the NCQA Customer Support Department at CustomerSupport@ncqa.org or toll free at (888) 275-7585.

 View a list of Aetna network physician practices recognized by the NCQA Physician Practice Connections Recognition Program here.

NOTE:

• Please verify that the doctor participates in your plan by clicking on the “Provider Detail” link in DocFind®
• National Advantage Program (NAP) participating doctors (unless designated as participating in other plans such as HMO) cannot be selected as a primary care physician.
• Services rendered by some doctors may be provided at the out of network level of benefits under your plan.
• Doctors with this symbol may participate with Aetna through an agreement that Aetna has with a vendor. The doctor may not be directly contracted with Aetna, and, consequently, not credentialed by Aetna. Doctors available through these vendors are subject to the credentialing requirements, if any, of the vendor. If you have questions, contact Aetna Member Services.

NCQA Back Pain Recognition Program
The goal of the Back Pain Recognition Program is to promote quality care for people with back pain. The National Committee for Quality Assurance developed standards to measure the care doctors provide. The program is voluntary. Doctors submit data showing how they meet the standards. The program then highlights doctors who meet the standards. Doctors listed in DocFind who meet the standards have a symbol next to their names.

 View a list of Aetna network doctors recognized by the NCQA Back Pain Recognition program here.

NOTE:

• Please verify that the doctor participates in your plan by clicking on the “Provider Detail” link in DocFind®
• National Advantage Program (NAP) participating doctors (unless designated as participating in other plans such as HMO) cannot be selected as a primary care physician.
• Services rendered by some doctors may be provided at the out of network level of benefits under your plan.
• Doctors with this symbol may participate with Aetna through an agreement that Aetna has with a vendor. The doctor may not be directly contracted with Aetna, and, consequently, not credentialed by Aetna. Doctors available through these vendors are subject to the credentialing requirements, if any, of the vendor. If you have questions, contact Aetna Member Services.

Leapfrog/Patient Safety
Patient safety is one of the nation’s most pressing health challenges. Since the publication of the Institute of Medicine’s (an advisory group to the federal government) 1999 report on medical errors, To Err Is Human, public attention has focused on patient safety and the prevention of medical errors.

Aetna is committed to educating our members about patient safety and currently has several initiatives in place to promote medical error reduction. Aetna is complementing these initiatives by supporting The Leapfrog Group’s efforts.

The Leapfrog Group is a growing consortium of Fortune 500 companies and other large private and public health care purchasers focused on helping consumers make more informed health care choices and encouraging more stringent patient safety measures. The Leapfrog Group is committed to using its collective purchasing power to help initiate breakthrough improvements in health care quality.

The patient safety measures ("leaps") being promoted by The Leapfrog Group are:

• Computer Physician Order Entry (CPOE) – CPOE systems can eliminate errors caused by misreading or misinterpreting handwritten prescriptions. They also can intercept prescriptions that might results in adverse drug reactions. CPOE has been shown to reduce serious prescribing errors by more than 50%.
  
  
• Evidence-Based Hospital Referral (EHR) – For certain elective and complex procedures and treatments, referrals to hospitals and providers offering the best survival odds can reduce a patient’s risk of dying by more than 30%.
  
  
• Intensive Care Unit (ICU) Physician Staffing – Staffing ICUs with physicians who have credentials in critical care medicine has been shown to reduce the risk of patients dying in the ICU by more than 10%.
  
  
• Quality Index – Specific practices that, if utilized, would reduce the risk of harm in certain processes, systems or environments of care, are the basis for the Quality Index. The practices are based on the National Quality Forum - endorsed 30 Safe Practices. The National Quality Forum is a not-for-profit organization created to develop and implement a national strategy for health care quality measurements and reporting. For information on the specific practices go to:
  http://www.leapfroggroup.org/for_consumers/hospitals_asked_what
  
  
• The Leapfrog Group also provides information on
  • Hospitals’ risk-adjusted state or national mortality rated for coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) and
  • Hospital adherence to certain proven processes of care that are linked to overall better care outcomes for CABG, PCI, Abdominal Aortic Aneurysm repair and high-risk deliveries. To access this information please go The Leapfrog Group’s website listed below.

For additional information on The Leapfrog Group, visit www.leapfroggroup.org.

 View a list of Aetna’s participating network hospitals that meet The Leapfrog Group’s safety measures here.

The Leapfrog Group data was collected and compiled by Medstat (www.medstat.com). The Leapfrog Group neither endorses nor warrants the quality of the data in this display other than The Leapfrog Group’s data and neither endorses nor warrants the methodology used in this display to compile data from different sources.

Note:Please verify that the hospital participates in you plan by clicking on "View plans hospital participates in" link in DocFind®.

Legend for the Hospital Listing:

• Fully Implemented = Fully Implemented Leapfrog’s recommended safety practice.
  
  
• Good progress = The hospital has already begun to implement the practice, has a clear action plan, and has committed the resources to achieve full implementation of the safety practice within the next few years.
  
  
• Good early stage = The hospital has developed an action plan and is committed to implementing the practice in the next few years.
  
  
• Willing to report = The hospital, while willing to report its implementation status, does not meet Leapfrog’s criteria for a good early stage effort of implementing Leapfrog’s safety practice.
  
  
• Did not disclose = The hospital was invited to fill out the survey but did not submit any information online to respond to Leapfrog’s survey. It can also mean that the hospital did not submit information for a specific section of the survey.
  
  
• N/A = Does not apply
  
  
• E = Exceeds the recommended number of procedure performed per year
  • Coronary Artery Bypass – 450 or more per year
  • Percutaneous Coronary intervention – 400 or more per year
  • Abdominal aortic aneurysm repair – 50 or more per year
  • Pancreatic resection – 11 or more per year
  • Esophagectomy – 13 or more per year
  • High –risk delivery – Neonatal ICU with average daily census of 15 or more
  
  
• M = Meets the recommended number of procedure performed per year
  
  
• D = Does not meet the recommended number of procedures performed per year.

Aetna's Process for Checking Physician & Hospital Information and Credentials
Is a systematic approach to assessing the qualifications of potential and existing providers through a review of relevant training, experience, licensure, certification, and/or registration to practice in a health care field; includes review of historical records to ascertain that potential providers have the required academic background and an acceptable record on issues relating to professional competence and conduct.

Find out more about Aetna's Process for Checking Physician & Hospital Information and Credentials

• Doctor Credentialing
• Dental Credentialing
• Hospital Credentialing

Speak Up^TM
Speak Up^TM is a national campaign sponsored by the Joint Commission. Speak Up urges consumers to take an active role in preventing health care errors by becoming active, involved and informed participants of the health care team. Speak Up brochures are available with tips for surgical patients, living organ donors, and research study participants, as well as how to prevent infection, how to prevent medication mistakes, and how to plan your recovery following hospitalization. The program encourages the public to:

• Speak Up if you have questions and concerns, and if you don't understand, ask again.
• Pay attention to the care you are receiving.
• Educate yourself about your diagnosis, the medical tests you are undergoing, and your treatment plan.
• Ask a trusted family member or friend to be your advocate.
• Know what medications you take and why you take them.
• Use a hospital, clinic, surgery center, or other type of health care organization that has undergone a rigorous on-site evaluation against established state-of-the art quality and safety standards such as that provided by the Joint Commission.
• Participate in all decisions about your treatment.

Aetna Important Health and Wellness Reminders
Aetna sends member health education reminders to HMO-based plan members via mail and/or e-mail at certain ages and stages of their lives, making them aware of screenings and other important preventive services. These reminders, to be used in conjunction with care and advice from a physician, encourage members to get services to prevent and detect and monitor conditions early on, when they are most treatable. Topics include:

• Adolescent Immunizations
• Women's Health Topics
• Childhood Immunizations
• Influenza and Pneumococcal vaccines and Colorectal Cancer Screening
• Hypertension and Cholesterol Management.

CA Pay for Performance
California Pay for Performance program results are shared for public viewing on the State of California Office of the Patient Advocate website http://www.opa.ca.gov/report_card/ and on the Integrated Healthcare Association website http://www.iha.org.

Integrated Healthcare Association (IHA)
This group works to improve health care for the people of California. Members include health plans, doctors and hospitals. The group rewards doctors for quality care and promotes programs that try to prevent obesity.

Office of the Patient Advocate (OPA)
This group teaches Californians about HMOs. It issues a report on the quality of HMOs. And it creates educational materials and works with patient support groups.

California Hospital Assessment and Reporting Taskforce (CHART)
This group created a report on hospital quality information in California. Available to the public, the report includes clinical data and patient satisfaction survey results. The report is located on this website: CalHospitalCompare.org