Quality Metrics

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Physicians Health Choice takes a unique approach to contracting with physicians. We believe our network should be made up of providers that practice medicine with a focus on prevention and the personal attention that our members need.

Our Primary Care Physicians are evaluated by their compliance to our nine quality and process metrics. These are:

  • All patients seen annually - PCPs are expected to see all their patients at least once per year, ideally to include a physical and routine lab work.
  • New patients are seen by their PCP within 90 days - PCPs are expected to conduct a health history and examination within 90 days of a member enrolling on their panel. This ensures a timely care plan is put in place, chronic and acute conditions are treated, and appropriate labs and referrals are initiated.
  • Patients must be seen within seven days after being discharged from the hospital. This ensures the discharge plan is clear to the member, medications are reconciled, and post acute care is coordinated by the Primary Care Physician.
  • Patients must have the appropriate ICD-9 (diagnosis) coding- this ensures that appropriate funding is received from Medicare for the Medical Risks of the member.
  • Patients with Ischemic Heart Disease have their LDL checked at least once annually to ensure that the member’s lipid status is being followed and treated by the PCP.
  • Patients with Congestive Heart Failure are prescribed and compliant on ACE/ARB.
  • Diabetic patients have A1c testing conducted at least annually.
  • Diabetic patients have their blood pressure closely monitored and controlled, desired level is currently 130/80 or below at least once annually.
  • Generic medications are prescribed appropriately to help patients control costs.