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NCQA Diabetes Recognition Program


The National Committee for Quality Assurance's (NCQA) Diabetes Recognition Program (DRP) recognizes clinicians who have met standards demonstrating delivery of high-quality care to patients with diabetes. Clinicians who achieve DRP Recognition show their peers, patients and others in the diabetes community that they are part of an elite group that is publicly recognized for its skill in providing the highest-level diabetes care.

The NCQA's DRP is a voluntary effort to identify clinicians and group practices who provide diabetes care consistent with the comprehensive diabetes care measures within the Healthcare Effectiveness Data and Information Set (HEDIS®)1 Doctors listed in DocFind® who meet the standards have a link next to their names under "More Information."

1HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA)

For more information you can go to NCQA Diabetes Recognition Program or to search for clinician go to NCQA Recognition Directory.

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.

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NCQA Heart/Stroke Recognition Program


The National Committee for Quality Assurance's (NCQA) Heart/Stroke Recognition Program (HSRP) means that clinicians have met standards showing they are providing high quality, evidence-based care for their CVD and stroke patients. This voluntary program is designed to recognize clinicians who have met standards demonstrating delivery of high-quality care to patients with cardiovascular disease and/or stroke.

Doctors listed in DocFind® who meet the standards have a link next to their names under "More Information."

For more information you can go to Heart/Stroke Recognition Program or to search for clinician go to NCQA Recognition Directory.

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.

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NCQA Physician Practice Connections Recognition Program

The National Committee for Quality Assurance's (NCQA) Physician Practice Connections®1 (PPC) recognizes practices that use systematic processes and information technology to enhance the quality of patient care. Practices who meet the PPC Connection standards demonstrate they have established connections to information, patients and other providers that allow them to:

  • Know and use patient histories
  • Follow up with patients and other providers
  • Manage patient populations and use evidence-based care
  • Employ electronic tools to prevent medical errors

Doctors listed in DocFind® who meet the standards have a link next to their names under "More Information."

1Physician Practice Connections® OR PPC® OR Physician Practice Connections®- Patient Centered Medical HomeTM OR PPC®-- PCMHTM is a registered trademark of the National Committee for Quality Assurance.

For more information you can go to NCQA Physician Practice Connections or to search for clinician go to NCQA Recognition Directory.

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.

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Physician Practice Connections® - Patient Centered Medical Home™
(PPC®-PHYSICIAN PRACTICE CONNECTIONS®-PATIENT-CENTERED MEDICAL HOME PPC®-PCM™)

The National Committee for Quality Assurance's (NCQA) Physician Practice Connections® The Patient-Centered Medical Home1 (PPC®-PCMHTM) program reflects the input of the American College of Physicians (ACP), American Academy of Family Physicians (AAFP), American Academy of Pediatrics (AAP) and American Osteopathic Association (AOA) and others in extension of the Physician Practice Connections Program. The program was developed to assess whether physician practices are functioning as medical homes and recognize them for these efforts. The Patient-Centered Medical Home standards emphasize the use of systematic, patient-centered, coordinated care that supports access, communication and patient involvement.

Doctors listed in DocFind® who meet the standards have a link next to their names under "More Information."

1Physician Practice Connections® OR PPC® OR Physician Practice Connections®- Patient Centered Medical HomeTM OR PPC®-- PCMHTM is a registered trademark of the National Committee for Quality Assurance.

For more information you can go to NCQA Physician Practice Connections or to search for clinician go to NCQA Recognition Directory.

NOTE:

  • Please verify that the doctor participates in your plan by clicking on the "Provider Detail" 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.

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NCQA Patient-Centered Medical Home Recognition Program 2011 or 2014

The National Committee for Quality Assurance's Patient-Centered Medical Home (PCMH) Recognition Program reflects the input of the American College of Physicians (ACP), American Academy of Family Physicians (AAFP), American Academy of Pediatrics (AAP) and American Osteopathic Association (AOA) and others. This program was developed to assess whether physician practices are functioning as medical homes and recognize them for these efforts. The NCQA PCMH standards emphasize the use of systematic, patient-centered, coordinated care that supports access, communication and patient involvement.

Doctors listed in DocFind® who meet the standards have a link next to their names under "More Information."

1Physician Practice Connections® OR PPC® OR Physician Practice Connections®- Patient Centered Medical HomeTM OR PPC®-- PCMHTM is a registered trademark of the National Committee for Quality Assurance.

For more information you can go to NCQA PCMH Program or to search for clinician go to NCQA Recognition Directory.

NOTE:

  • Please verify that the doctor participates in your plan by clicking on the "Provider Detail" 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.

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NCQA Patient-Centered Specialty Practice

The National Committee for Quality Assurance's (NCQA) Practices that become recognized under Patient-Centered Specialty Practice Recognition (PCSP)have demonstrated commitment to patient-centered care and clinical quality through: streamlined referral processes and care coordination with referring clinicians, timely patient and caregiver-focused care management and continuous clinical quality improvement. Earning NCQA PCSP Recognition shows consumers, private payers and government agencies that the practice has undergone a rigorous review of its capabilities and is committed to sharing information and coordinating care. Recognition also signals to primary care practices that the specialty practice is ready to be an effective partner in caring for patients.

For more information you can go to NCQA PCSP Program or to search for clinician go to NCQA Recognition Directory

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Leapfrog/Patient Safety

Patient safety is one of the nationís most pressing health challenges. Since the publication of the Institute of Medicineís (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 Groupís 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 Leapfrog Hospital Survey collects data on hospital performance in the following categories:

This is a table for brief description
Section Title Brief Description
Computerized Physician Order Entry (CPOE) Medication errors are the most frequent type of error that occurs in hospital. Hospitals can use Computerized Prescriber Order Entry (CPOE) systems to order medications for patients in the hospital, instead of writing out prescriptions by hand. Good CPOE systems alert hospital staff if they try to order a medication that could cause harm, such as prescribing an adult dosage for a child. This section of the Leapfrog Hospital Survey is one of The Leapfrog Groupís original quality and safety standards, and is designed to determine how a hospital uses CPOE to prevent medication errors.
Evidence-Based Hospital Referral (EBHR) Outcomes of high-risk surgeries can vary greatly based on the hospitalís skill at performing the procedure. This section of the Leapfrog Hospital Survey is one of The Leapfrog Groupís original quality and safety standards, and provides a predicted survival rate for four procedures: esophagostomy (surgery to remove all or part of the esophagus), pancreatectomy (surgery to remove all or part of the pancreas), abdominal aortic aneurism (surgery to treat enlargement of a major blood vessel), and aortic valve replacement (surgery to repair heart valves). Patients who need one of these procedures should select a hospital for their care that has the best odds of survival.
Maternity Care Having a baby is one of lifeís most exciting experiences, but the type of care received in the hospital can vary greatly. This section of the survey examines a hospitalís rate of C-sections, early elective deliveries, and episiotomy, as well as performance on standard processes of care and delivery outcomes in high-risk situations. Women and families should use this information to consider which hospital theyíd like to use for their childís delivery.
ICU Physician Staffing (IPS) A critical care unit or Intensive Care Unit (ICU) is a special part of the hospital that provides care for extremely ill patients. Hospitals should have special doctors called intensivists working in the ICU. Intensivists are physicians with advanced training in intensive or critical care. They learn to manage problems in the ICU and help to reduce errors. There are higher death rates in hospitals where ICU patients are not cared for by intensivists. This section of the Leapfrog Hospital Survey is one of The Leapfrog Groupís original quality and safety standards, and is designed to determine whether or not patients in ICUs are cared for by physicians certified in critical care.
Safe Practices Score (SPS) Leapfrog asks hospitals to report on their implementation of eight practices that, if adopted, can improve patient safety in health care settings. Each of the eight safe practices includes four components: awareness, accountability, ability, and action, and then includes a list of activities that every hospital should accomplish. Patients should choose a hospital that has all of the safe practices fully implemented in order to achieve a higher likelihood of a safer hospital stay. This section is one of The Leapfrog Groupís original quality and safety standards.
Managing Serious Errors Hospital-acquired conditions (HACs) are medical conditions or complications that were not present when a patient was admitted to the hospital, but develop as a result of errors or accidents in the hospital. This section of the survey contains rates of four types of HACs: Hospital-acquired pressure ulcers, Hospital-acquired injuries, Central line-associated bloodstream infections, and Catheter-associated urinary tract infections. Hospitals can prevent many of these conditions; some hospitals have zero or close to zero reported HACs. This section also examines if hospitals have a Never Events policy in place to apologize to the patient and waive all costs if something that should never happen does in fact happen to a patient.
Bar Code Medication Administration Hospitals can include a barcode on each patientís ID bracelet. Every time a nurse or other provider gives that patient a medication, they should scan both the patientís bracelet and the barcode on the medication itself. If the barcodes donít match, this signals that the wrong medication could be given to the patient. Using barcodes helps reduce the risk of medication errors. This section of the Leapfrog Hospital Survey was new in 2015 and is designed to demonstrate a hospitalís use of bar code medication administration.
Readmission for Common Acute Conditions A readmission occurs when a patient who has been discharged from the hospital returns for another hospital stay within 30 days. Hospitals should work to ensure that patients get the best care during their initial hospital stay so that they donít have to come back for more inpatient care. This section of the survey is designed to demonstrate a hospitalís performance on readmission for six conditions: heart attack, heart failure, pneumonia, chronic obstructive pulmonary disease, coronary artery bypass graft, and total hip/total knee replacement.

For additional information on The Leapfrog Group, visit Leap Frog Hospital Safety.

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

Legend for the Hospital Listing:

  • Fully Meets Standards = Fully meets Leapfrogís recommended safety practice.

  • Substantial 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.

  • Some progress = 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 Leapfrogís criteria for implementing the practice in the next few years.

  • Declined to Respond = The hospital was invited to fill out the survey but did not submit any information online to respond to Leapfrogís survey. It can also mean that the hospital did not submit information for a specific section of the survey..

  • Response Not Required = The hospital was not asked to provide a response.

  • Does Not Apply = The specific measure does not apply to the hospital (N/A)

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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

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Speak UpTM

Speak UpTM 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.
All of the Speak Up initiatives can be accessed at The Joint Commission

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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.
To access this information click on Manage your benefits


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How to submit a comment, concern or complaint about physician performance programs

Please tell us if you are not satisfied with any of the physician performance programs such as Bridges to Excellence, NCQA Recognition or California Pay for Performance. To do this, call Member Services. The telephone number is on your ID card. If you're not satisfied after talking to a Member Services representative, you can ask to have your issue sent to the appropriate department.




 
     
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