physician satisfaction survey: tell us what you think in ... · importantinformation for healthcare...

For more information

Call our Provider Service Centerat 877-842-3210

Visit UHCCommunityPlan.com

In This Issue:

• Physician Satisfaction Survey:Tell Us What You Think . . . . . . . . . . 1

• Our Employees Ensure Satisfaction . . 2

• Submitting Claims Electronically . . . 2

• The use of Progesterone in thePrevention of Preterm Births . . . . . . . 3

• Appointment Standards . . . . . . . . . . . 8

• Are your patients Satisfied:The CAHPS Survey . . . . . . . . . . . . . 8

• Health Literacy . . . . . . . . . . . . . . . . . 9

• Did You Know? . . . . . . . . . . . . . . . . . 9

• Congratulations . . . . . . . . . . . . . . . . 10

• Coordination of Care betweenPrimary Care Physicians andSpecialists . . . . . . . . . . . . . . . . . . . . . 11

Important information from UnitedHealthcare for physicians and other health careprofessionals and facilities serving UnitedHealthcare Medicaid members

Physician Satisfaction Survey:Tell Us What You Think

UnitedHealthcare Community Plan is committed to makingsure that our service and programs support your practice inproviding quality care to your patients who are our members.We value and seek administrative simplicity that takes thehassles out of clinical practice and reduces inefficiency andwaste. For this reason, we periodically offer a random sampleof network physicians the opportunity to provide feedback onour services.

Next month, August 2012, UnitedHealthcare CommunityPlan will launch its annual Physician Satisfaction survey.You may receive an invitation to complete the surveyallowing you to evaluate the services and programs providedto your practice.

Your opinions will help identify and prioritize opportunitiesfor improvement and assess the level of satisfaction with ourhealth plan. This feedback is critical in helping us to bettermeet the needs of your practice. Your input will help us createsimpler and innovative solutions for you and your practice.If you receive the survey, we appreciate your time and supportand thank you for your feedback.

Summer 2012

Important information for health care professionals and facilities

I Summer 2012 2 Provider Service Center: 877-842-3210

(continued on next page)

Ensuring Satisfaction

Employees who represent Our United Cultureare what make the UnitedHealth Groupcommunity special and unite us in our mission tohelp people live healthier lives — and we want toshare their stories.

Joseph Tullmann

Joseph Tullmann, a customer careprofessional on OptumHealth’s Behavioral

Solutions team in Maryland Heights,Missouri, embodies our culture bypatiently and compassionately buildingrelationships with our providerpartners. OptumHealth BehavioralSolutions works with providers tocoordinate behavioral health servicesthat help adults and children on

Medicaid obtain high-quality care at theright time and place. Recently, a provider sentthe following message in response to hisexperience with Joseph.

“I spoke with Joe today and he was able toanswer all of my questions. I can say I havenever had an experience like this dealing withany insurance company.He was thoroughand patient. I don’t consider myself to be adifficult person, but I had some difficultquestions and he was able to answer all ofthem. Joe did a phenomenal job and I reallyappreciate it.”

Thank you, Joseph, for your commitment toexcellent service by ensuring our customersfeel understood, informed and satisfied.

Submitting Claims Electronically

Did you know by converting 10,000 paperclaims, remittance advice, and reimbursementsto electronic transmittal (EDI, EFT, and ERA)we could:• Save 3729 pounds of paper

• Eliminate 148,389 pounds of greenhouseemissions (Equivalent to 1726 new trees grownfor 10 years or 20,451 square feet of forestconserved)

• Average practice can save thousands of dollarsper year by converting to electronictransmission.

*Source : www.payitgreen.org

Getting Started with EDI is simpleTo submit claims electronically: have your officesoftware vendor or clearinghouse makeconnection to UnitedHealthcare’s clearinghouseOptumInsight.

OptumInsight.com800-341-6141

UnitedHealthcareCommunity Plan PayerID: 25175Contact our EDIDepartment to learn aboutno cost solutions for EDIUnitedHealthcareCommunity Plan EDI Support [email protected]/health-professionals

Submit single or batch claims directly to usthrough the secure Provider Portal by going toUHCCommunityPlan.com/health-professionals

www.OptumInsight.com

www.UHCCommunityPlan.com/health-professionals




www.OptumInsight.com



Receive Payment for claims electronically(EFT)EFT is safe, secure, efficient, and more costeffective than paper claim payments. You canfind the EFT enrollment form on our website, ifyou would like to save money and time, enrolltoday! Enrollment forms can be found atwww.uhccommunityPlan.com/health-professionals > State > EDI Section

Receive Remittance Advice Electronically(ERA)To enroll in ERA contact your software vendorand/or clearinghouse

BREAKINGNEWS: NOWAVAILABLEReal Time Electronic Eligibility Inquiry andResponseTransactions (271/271)Real Time Electronic Claim Status andResponseTransactions (276/277)

Confirming Eligibility, Benefits, and ClaimStatus doesn’t have to be time consuming.UnitedHealthcare Community Plan now offersREAL TIME electronic Eligibility Inquiry andResponse as well as Claim Status and Responseto help streamline the process.

For additional information please contactOptumInsight HIN Sales Team at (800) 341-6141 option 3.

COB (Secondary) EDI Claims Submissionsare preferred electronically• Please refer to the 837 Companion Guidelocated on our website or simply call our EDISupport services at 800-210-8315 or email usat [email protected] we would be happyto assist with setup.

• Do not send paper claim backup for claimsthat have already been submitted Electronically

Electronic Claim SubmissionTips• Include your tax identification number (TIN)along with your NPI number

• Member ID Numbers are required

• The Payer ID number indicates whereclearinghouses should direct their claims.

The use of Progesterone in thePrevention of Preterm Birthsby Gordon B. Kuttner, MD, Sr. National MedicalDirector at UnitedHealth Group

Preterm birth is definedas birth occurring priorto 37 completed weeksof gestation. Theburdens that commonlyresult from pretermbirths are emotionaland financial, short-term and long-term.Preterm births mayresult in developmentaldelays, life longdisabilities, and seriousmedical complicationsincluding cerebral palsy,sensory deficits, chroniclung disease, blindness, and hearing loss. Morethan one-third of deaths occurring within thefirst year of life are attributable to preterm-related causes. In 2005, the Institute of Medicineestimated that preterm births cost the U.S. atleast $26.2 billion ($51,600 for every infant bornprematurely). These costs include medical andeducational expenses and associated loss ofproductivity.

There are multiple causes for preterm births.Causes of preterm birth are both iatrogenic(appropriate and inappropriate) and spontaneous.By now, most providers of obstetrical services areaware of the increased risks of delivering a baby


(continued from previous page)



prior to 39 weeks gestation without a medicalmaternal or fetal indication. Additionally, mostcaregivers are familiar with the use ofprogesterone injections for the prevention ofspontaneous premature births. As with anycondition, the appropriate choice of treatment isdependent on factors inherent in each patient.This appears true with progesterone and its usein two separate high risk populations: (1) thosewith a singleton pregnancy who have a shortcervix and (2) those women with a singletonpregnancy who had a prior spontaneoussingleton, live born, preterm delivery associatedwith preterm labor between 20.0 and 36.6 weekswith a normal cervical length in the currentpregnancy.

The two risks factors for spontaneous pretermbirths (SPB) respond differently to differentforms and routes of administration ofprogesterone. Based on the current research(which is constantly evolving):

• Short Cervix (< 25 mm): responds to the useof micronized progesterone vaginal gel (and toa lesser extent compounded vaginalsuppositories), but does not respond to 17Alpha-Hydroxyprogesterone Caproate (17P)injections. Micronized progesterone vaginalgel (and compounded vaginal progesterone)appears to benefit those pregnancies that arefound to have a short cervix, regardless ofwhether they have a history of SPB. A meta-analysis by Romero (see below) evaluatedmultiple gestations and revealed no benefit inreduction in PTBs or NICU admissions, butdid see a benefit on composite neonatalmorbidity and mortality.

• History of SPB with Normal CervicalLength: responds to the use of 17 Alpha-Hydroxyprogesterone Caproate (17P)injections for singletons and not multiples.17P injections have not been proven to

decrease preterm birth in women with a shortcervix who have not had a PTB. Those with aprior history of a SPB and short cervix in thecurrent pregnancy appear to benefit from onlyvaginal micronized progesterone without 17Pinjections.

Short CervixIn an article published in the February 2012issue of American Journal of Obstetrics &Gynecology, Romero and colleagues, withfunding from the NICHD, NIH, and DHHS,performed a systematic review and meta-analysisof individual patient data demonstrating thattreatment with vaginal progesterone in womenwith asymptomatic sonographic short cervix (<25mm) in the midtrimester (19 0/7-23 6/7weeks gestation) results in a decrease in pretermdelivery and composite neonatalmorbidity/mortality, NICU admissions,mechanical ventilation and respiratory distresssyndrome. Five trails with 775 women and 825infants were used. Singletons represented 93.3 %pregnancies and 6.7% were twin pregnancies. In3 of the 5 studies cerclage was allowed afterrandomization. There was a significantreduction in the rate of PTB < 33 weeks (RR0.58, 95% CI 0.42-0.80), <35 weeks (RR 0.69,95% CI 0.55-0.88), and 28 weeks (RR 0.57, 95%CI 0.40-0.81). There was also a significantreduction in composite neonatal morbidity andmortality (RR 0.50, 95% CI 0.30-0.81) andadmissions to the NICU (RR 0.75, 95% CI0.59-0.94). The number of patients with a shortcervix who needed to be treated (NNT) toprevent one case of PTB < 33 weeks was 11(95%, CI 8-23), <35 weeks, 11, <34 weeks 9, and< 28 and 30 weeks, 18. With regard to singletonand twins gestations, there were significantreductions in PTB < 33 weeks in only thesingleton group, 44% reduction vs placebo (CI0.4-0.8). Additionally, NICU admission





reductions, 33%, were statistically significant onlyin the singleton pregnancies (CI 0.5-0.91).However, both singletons and twins showed astatistical reduction in composite neonatalmorbidity and mortality. Vaginal progesteronewas associated with a significant reduction inPTB < 33 weeks in both women with a singletongestation with no previous PTB (RR 0.60, 95%CI 0.39-0.92) as well as those with a singletonpregnancy and at least one prior PTB between20-37 weeks (RR 0.54, 95% CI 0.30-0.98).

American College of Obstetricians andGynecologists (ACOG) released CommitteeOpinion No. 522 (April 2012) on incidentallydetected short cervical length. ACOG’sCommittee on Obstetric Practice recommendsthe following management options to reduce therisk of preterm birth in women with incidentallydetected short cervical length:

• Cervical length screening by transvaginal (nottransabdominal) ultrasound examination hasbeen proven to help predict preterm birth.The utility of universal cervical lengthscreening for the prevention of preterm birth iscontroversial and being debated.

• In asymptomatic women with singletongestations without prior preterm birth with anincidentally identified very short cervicallength < 20 mm before or at 24 weeks ofgestation, vaginal progesterone (200-mgmicronized or 90-mg gel) may be consideredto reduce the risk of preterm birth.

• Women with singleton gestations with PTB ofa prior spontaneous, singleton, live born, andassociated with preterm labor or spontaneousrupture of membranes between 20.0 and 36.6weeks should be offered progesteronesupplementation, regardless of cervical lengthmeasured by transvaginal ultrasoundexamination, starting at 16 weeks of gestation.

• Cerclage for women with a singletonpregnancy, prior preterm birth at less than 34weeks of gestation, and short cervical length <25 mm before 24 weeks of gestation isassociated with perinatal benefits andsignificant decreases in preterm birth outcomesand may be considered.

• There are insufficient data on the efficacy ofinterventions for the prevention of pretermbirth in women with multiple gestations withboth a prior preterm birth and a short cervicallength. Cerclage may increase preterm birth inwomen with a twin pregnancy and a cervicallength of < 25 mm and is not recommended atthis time.

History of SPBFrom the time the Meis article was published inthe New England Journal of Medicine in 2003,many other studies have confirmed the benefit inPTB reduction using 17 Alpha-Hydroxyprogesterone Caproate (17P). Severalstudies have looked at the use of vaginalprogesterone in various delivery systems. Thereis now significant evidence that in those with ahistory of a PTB and a current singletonpregnancy with a short cervix may benefit fromvaginal progesterone alone. There is clearevidence from the literature that 17P IM doesnot change outcomes when administered towomen with multiple gestations.

Indications for 17 Alpha-HydroxyprogesteroneCaproate (17P) IMAsymptomatic women with at least one priorspontaneous (without medical cause for deliveryor due to cervical insufficiency), singleton, liveborn, with or without ruptured membranes,preterm delivery between 20.0 and 36.9 weeksassociated with preterm labor and initiating themedication between 16.0 and 26.9 weeks.(UnitedHealthcare Drug Policy number2011D0040A)





Indications for Micronized ProgesteroneVaginal Gel or Compounded VaginalProgesteroneAsymptomatic women with a singletonpregnancy and an ultrasound demonstrated shortcervix (< 25mm; [ACOG < 20 mm]) diagnosedbetween 19.0 and 23.9 weeks of gestation andinitiating the medication between 20.0 and 23.9weeks gestation.

UnitedHealthcare Community Plan’s TakeHomeMessage:1. Short cervix alone and short cervix with a

history of PTB both respond to a minimumof 90 mg of micronized progesterone vaginalgel every morning or compounded 200 mgprogesterone vaginally prior to sleep. Thereare no studies to suggest better outcomeswith the treatment of those with short cervixwith a history of PTB with combinedvaginal progesterone and 17P.

2. History of PTB with a normal cervicallength has been proven to respond to 250mg of 17P IM weekly and not vaginalprogesterone.

3. For those currently pregnant with twingestations with or without short cervixtreated with vaginal progesterone or 17P,there is no decrease in the rate of PTB orNICU admissions.

4. For those currently pregnant with twingestations with a short cervix treated withvaginal progesterone there is a statisticalreduction in composite neonatal morbidityand mortality, but not rate of PTB.

5. Cervical length screening by transvaginal(not transabdominal) ultrasound examinationhas been proven to help predict pretermbirth. Although the utility of universalcervical length screening for the preventionof preterm birth is controversial and being

debated, there appears to be a benefit toscreening pregnant women with singletonpregnancies with transvaginal ultrasoundmeasurement for cervical length performedby trained personnel between 19 and 24weeks of gestations and treatment with 90mg of micronized progesterone vaginal geldaily or compounded 200 mg progesteronevaginally daily for those found to have acervical length < 25 mm [ACOG < 20 mm]until 36 6/7 weeks of gestation.

UnitedHealthcare Community Plan supports theappropriate treatment for the appropriatepatient. For those members that meet thecriteria for 17P and do not have a Statesponsored pharmacy benefit, UnitedHealthcareCommunity Plan has a preferred relationshipwith Walgreens Specialty Pharmacy.WalgreensSpecialty Pharmacy will ship compounded,preservative-free 17P to a provider’s office andbill UnitedHealthcare Community Plan directly.Walgreens Specialty Intake staff can be reachedat Phone: 888-347-3415, Fax: 888-347-3417.

Additionally, UnitedHealthcare has a preferredrelationship with the Women’s and Children’sHealth division of Alere Health. This homehealth service offers a compounded, preservative-free 17P administration program, which includesin-home obstetric nurse administration,education about the risk factors and signs andsymptoms of preterm labor, weekly assessmentsand 24/7 nurse-line support. For moreinformation please contact Alere at800-950-3963.

UnitedHealthcare Community Plan requiresprior authorization for compounded 17Pwhether administered in the office or by a homehealth service. Although 17P is a medication, itis covered under the medical and not pharmacybenefit because it is not a self-injectiblemedication. At this time micronized





progesterone vaginal gel is covered by thepharmacy benefit and requires priorauthorization, unless the member is covered by aState Fee-for-Service Pharmacy Program andlives in Louisiana, Tennessee, Nebraska,Delaware, Texas, or Wisconsin. Authorizationsare based on medical necessity, which isdetermined by the drug policy, evidence-basedmedicine, state benefits, regulations, contractsand medical judgment. For UnitedHealthcareCommunity Plan members who do not have aState Fee-for-Service Pharmacy Program, 17Pand micronized progesterone vaginal gel will becovered under the patient’s medical or pharmacybenefit, respectively, in accordance with theircoverage.

For more information regarding the use of 17PIM please view the online provider bulletin atwww.uhccommunityplan.com and select 17Alpha-Hydroxyprogesterone Caproate (17P)Information with links to the UnitedHealthcareDrug Policy number 2011D0040A.

Physicians and health care providers may requestclinical review criteria used to make coveragedecisions. Please contact the Pharmacy PriorNotification department at 1-800-310-6826 torequest clinical review criteria.1. Romero R, Nicolaides K, Conde-Agudelo A, et al.

Vaginal progesterone in women with an asymptomaticsonographic short cervix in the midtrimester decreasespreterm delivery and neonatal morbidity: a systematicreview and metaanalysis of individual patient data. Am JObstet Gynecol 2012;206:124.e1-19.

2. Hassan SS, Romero R, Vidyadhari D, et al. Vaginalprogesterone reduces the rate of preterm birth in womenwith a sonographic short cervix: a multicenter,randomized, double-blind, placebo-controlled trial.Ultrasound Obstet Gynecol. 2011; 38: 18-31.

3. Anderson HF, Nugent CE,Wanty SD, et al. Predictionof risk for preterm delivery by ultrasonographicmeasurement of cervical length. Am J Obstet Gynecol.1990; 163: 859-867.

4. Rode L, Klein K, Nicolaides KH, et al. Prevention ofpreterm delivery in twin gestations (PREDICT): amulticenter, randomized, placebo-controlled trial on theeffect of vaginal micronized progesterone. UltrasoundObstet Gynecol. 2011: 38: 272-280.

5. Rode L, Klein K, Nicolaides KH, et al. Vaginalmicronized progesterone and risk of preterm delivery inhigh-risk twin pregnancies: a secondary analysis of aplacebo-controlled randomized trial and meta-analysis.Ultrasound Obstet Gynecol. 2011; 38: 281-287.

6. O’Brien JM, Adair CD, Lewis DF, et al. Progesteronevaginal gel for the reduction of recurrent preterm birth:primary results from a randomized, double-blind,placebo-controlled trial. Ultrasound Obstet Gynecol.2007; 30: 687-696.

7. Cetingoz E, Cam C, Sakalli M, et al. Progesteroneeffects on preterm birth in high-risk pregnancies: arandomized placebo-controlled trial. Arch GynecolObstet. 2011. 283: 423-429.

8. Fonseca EB, Celik E, Parra M, et al. Progesterone andthe risk of preterm birth among women with a shortcervix. N Engl J Med. 2007; 357: 462-8.

9. Iams JD, Goldenberg RL,Meis PJ, et al. The length ofthe cervix and the risk of spontaneous prematuredelivery. N Engl J Med. 1996; 334: 567-72.

10. Clinical Pharmacology Gold Standard 2012.11. Incidentally detected short cervical length. Committee

Opinion No. 522. American College of Obstetriciansand Gynecologists. Obstet Gynecol2012;119:879–82.




Appointment Standards

Primary Care PhysiciansPrimary Care- PCPs and providers of primarycare should arrange appointments for:

• Urgent care within 24 hours of request

• Routine care within 10 business days

• Health assessments and general physicalexaminations and first examinations within 3weeks of enrollment

• EPSDT screens fornew enrollees underthe age of 21 within45 days of enrollmentunless the child isunder the care of aPCP and the child iscurrent with screeningsand immunizations

• Appointment for newenrollees known to beHIV positive ordiagnosed with AIDS

within 7 days of enrollment unless the member isunder the active care of the PCP

• Appointment for new Supplemental SecurityIncome (SSI) enrollees within 45 days ofenrollment unless the member is under theactive care of the PCP

• Emergency Care immediately upon themember’s presentation at a service delivery siteor referral to an emergency facility.

Specialty CareSpecialists and specialty clinics should arrangeappointments for:

• Urgent care within 24 hours of request

• Routine care within 10 days of referral

• Appointment for new enrollees known to beHIV positive or diagnosed with AIDS withinseven days of enrollment unless the member isunder the active care of the specialist

• Appointment for new SSI enrollee within 45days of enrollment unless the member is underthe active care of the specialist

Prenatal CareUnitedHealthcare conducts proactiveidentification of pregnant women. Providers ofprenatal care should arrange appointments forthe initial prenatal visit after confirmation ofpregnancy:

• High risk pregnancies – within 24 hours ofidentification of high risk status orimmediately if an emergency exists

• First trimester – within 10 business days

• Second trimester – within five business days

• Third trimester – within four business days

Are your patients Satisfied:The CAHPS Survey

What is CAHPS?CAHPS (Consumer Assessment of HealthcareProviders and Systems) is a survey that isadministered annually by a third party vendor tomeasure member satisfaction with the servicesthey receive from UnitedHealthcare CommunityPlan of Pennsylvania both directly and throughour providers.

Members are contacted by mail and if there is noresponse to the mailing, the vendor follows upwith telephone calls.

UnitedHealthcare uses the survey results toidentify opportunities to improve membersatisfaction and provide quality healthcareservices.




CAHPS and our ProvidersMany of the questions in the CAHPS survey arerelated to the service members receive from theirprovider.We are sharing the results of theCAHPS surveys with you to:

What are our members saying…..results fromour recent CAHPS SurveyUnitedHealthcare Community Plan ofPennsylvania has scored well in the followingcategories:

• Rating of Specialist

• Rating of General Health Care

• How Well Doctor’s Communicate

Scores that indicate that improvement is needed:

• Rating of Personal Care Doctor

• Getting Care Quickly

• Customer Service

Health Literacy

In the report Healthy People 2010, the U.S.Department of Health and Human Servicesidentified health literacy as an importantcomponent of health communication, medicalproduct safety, and oral health. Health literacy isdefined in Health People 2010 as:

"The degree to which individuals have the capacityto obtain, process, and understand basic healthinformation and services needed to make appropriatehealth decisions."

Our mission at UnitedHealthcare is “helpingpeople live healthier lives”. To that end,providing clear medical information to ourmembership is a key component and goal of thismission. We know that you, our partners inproviding excellent care to our members, sharethe same goal. We have hired a Health LiteracyProgram Manager for the Northeast Region,

Erica G. Bradley, whose particular focus isPennsylvania. As we prepare to incorporate suchhealth literacy initiatives as Teach Back and AskMeThree into our United culture, we areexcited to learn about your health literacy bestpractices. Stay tuned for ongoing health literacytips as well as our campaign soliciting andcelebrating your health literacy ideas in futureissues.

We look forward to working together as wecontinue to enhance the lives of our members.

Did You Know?

UnitedHealthcare Community Plan’s OralHealth Initiative includes reimbursement offluoride varnish applications by primary careproviders. Under the Pennsylvania Departmentof Public Welfare Medicaid Program,Pediatricians andNurse Practitionerscan obtain paymentfor the applicationof topical fluoridevarnish. There arefour easy steps toget startedincluding thecompletion of anonline course andobtaining thecourse completioncertificate.

The varnish program has been established to:

• help improve the oral health care of children

• increase awareness of the importance of goodoral health care in young children

• assist in the establishment of a dental home.





We are happy to have this additional service forour PCPs.We value the critical role primary careproviders play in oral health care. After all, oralhealth care plays an integral role in one’soverall health.

Please contact Provider Services at 1-800-600-9007 or you can ask your Provider Advocate andClinical Practice Consultant for moreinformation.

Congratulations!

UnitedHealthcare Community Plan would liketo congratulate these exceptional hospitals forreaching the standards designated to berecognized as a Gold Star II Hospital in thefollowing categories.

Hospital Reduction of Infection Program –These hospitals have achieved a 5% reduction ininfection rates per thousand cases, as identifiedin the annually published infection data fromPHC4.

Allegheny General HospitalAlle-Kiski Medical CenterChambersburg HospitalHamot Medical CenterIndiana Regional Medical CenterJameson Health SystemsLancaster General HospitalLehigh Valley HospitalMemorial Hospital of YorkMoses Taylor HospitalMilton S. Hershey Medical CenterPinnacle Health HospitalsSaint Vincent Health CenterSchuylkill Medical CenterSouthwest Regional Medical CenterUPMC McKeesportUPMC MercyWashington Hospital

Hospital NICU Utilization Program – Thesehospitals have demonstrated a provision ofeffective service and have executed successfuldischarge planning for 100% of theirUnitedHealthcare Community Plan memberstreated in the NICU.

Conemaugh Memorial HospitalEphrata Community HospitalHamot Medical CenterHoly Spirit HospitalLancaster General HospitalLehigh Valley HospitalUPMC Magee–Womens HospitalMoses Taylor HospitalMilton S. Hershey Medical CenterPinnacle Health HospitalsPocono Medical CenterSaint Vincent Health CenterSt. Joseph Medical CenterUPMC MercyWestern Pennsylvania HospitalWest Virginia University HospitalWestern Pennsylvania Hospital Forbes CampusWestmoreland Regional HospitalYork Hospital

Thank you to our participating hospitals forproviding excellent service to all of ourUnitedHealthcare Communty Plan members.




Coordination of Care between PrimaryCare Physicians and Specialists

UnitedHealthcare wants to underscore theimportance of ongoing communication betweenPrimary Care Physicians and Specialists. Below,please find information and suggestions on waysto keep the lines of communication open tosupport the best care possible for your patientswho are UnitedHealthcare members.

Primary Care Physiciansand specialists shareresponsibility forcommunicating essentialpatient informationregarding consultationsand referrals. Both groupsagree that failure toconsistently communicatethreatens their ability toprovide high-quality care.According to a recent

study, there is a difference of opinion amongproviders regarding the frequency of informationprovided and received. Though 69.3% of primarycare physicians said they send specialistsnotification of a patient's history, and the reasonfor the consultation all or most of the time, just34.8% of specialists said they routinely receivesuch information, according to the study.

Meanwhile, 80.6% of specialists say they sendconsultation results to the referring physician allor most of the time, but only 62.2% of PrimaryCare Physicians say they ever get thatinformation. (Arch Intern Med. 2011 Jan10;171(1):56-65).

Relevant information from the Primary CarePhysician includes the patient’s history, diagnostictests and results and reason for the consultation.The specialist is responsible for communicatingthe results of the consultation and ongoingrecommendations and treatment plans.

Information exchange between providers shouldbe timely, relevant and accurate to facilitateongoing patient management. The partnershipbetween the Primary Care Physician andspecialist is based on the consistent exchange ofclinical information and this communication is akey factor in providing quality patient care.

Provider Service Center: 877-842-3210

Practice Matters is a quarterly publication for physicians and other health care professionals and facilitiesin the UnitedHealthcare network.

M47507PA 5/12

300 Oxford DriveMonroeville, PA 15146

physician satisfaction survey: tell us what you think in ... · importantinformation for healthcare...

Documents