Taking the Guess Work Out of Finding the Right Doctor

JOURNAL: ISSUE 1 - 2012

The International Health Fund (IHF) partners with United Healthcare to provide tools that help members and their families make informed health care choices, like selecting physicians and facilities that meet national quality standards.

One such tool available to IHF members is the UnitedHealth Premium designation program, which offers easy access to a wide range of medical information in one place, and also recognizes physicians and hospitals whose practices are consistent with evidence-based standard. Evidence-based medicine entails the conscientious, explicit and judicious use of current best evidence in making decisions about the care or individual patients. It is important to find a provider who practices evidence-based medicine as this indicates a provider who is balancing individual clinical expertise with the best clinical evidence available through research. In fact, finding the right doctor is one of the most important health care decisions an IHF participant or a covered family member can make, especially when a diagnosis involves a chronic or critical illness.

To search for physicians that are designated as UnitedHealth Premium providers, IHF members can visit the United Healthcare website at www.uhc.com and select Find a Physician. There, members can also find providers recognized by the National Committee for Quality Assurance (NCQA), an independent, third-party specialty organization that establishes strict criteria that physicians and other health care providers must meet based on actual medical outcomes with their patients. These recognition programs help identify providers that have met accepted standards of care for a given condition.

Three other quality assurance programs are available to IHF members at no additional cost:

AHA/ASA/NCQA Heart/Stroke Recognition Program (HSRP): The HSRP, a partnership of the American Heart Association (AHA), American Stroke Association (ASA) and National Committee for Quality Assurance (NCQA), is a voluntary program for individual physicians or physician groups that treat patients with cardiovascular disease or who have had strokes.

• Primary care and specialist physicians achieve recognition by submitting data that confirms their efforts to help patients avoid further complications from heart disease and/or another stroke.

ADA/NCQA Diabetes Recognition Program: This Program, co-sponsored by the American Diabetes Association (ADA), is a voluntary program for individual physicians or physician groups that treat patients with diabetes.

• Physicians achieve recognition by submitting data that shows they are providing quality diabetes care. The Program assesses key measures that relate directly to improved care for people with diabetes.

NCQA Back Pain Recognition Program (BPRP):  The BPRP recognizes physicians that provide care that best meets their patients' needs, restores patients' health and mobility, and avoids unnecessary treatment and tests.

• Physicians achieve recognition by submitting data that demonstrates that the back pain care they provide meets the NCQA requirements. The BPRP consists of 13 clinical measures and three structural standards, such as the elements of the physical exam and advice for the return to normal activities.

In addition to the quality metrics offered by these programs, IHF members can also use the United Healthcare website to estimate out-of-pocket medical expenses – just look for the Estimate Health Plan Costs link at www.uhc.com.

These programs and tools are available at no additional cost. Finding a provider that offers both quality and cost efficient care can protect you and your family, save money, and provide piece of mind. And while it may be one of the most important health care decisions you have to make, remember that IHF is here to help.

If your Local Union belongs to the IHF and you have questions, please contact Robin Donovick at 202-383-3976