Selecting a Primary Care Physician

Please Note: This information only applies to Care Choices HMO Members.

The articles linked below will help you to review key professional qualities when selecting a primary care physician (PCP) or to use when you are referred to a specialist.

Selecting A Personal Physician
Verifying Provider Credentials
Questions to Ask About A Provider

Selecting a Primary Care Physician

When you joined Care Choices HMO, you should have chosen a primary care physician (PCP). You can choose a PCP from our current Provider Directory.

Our directory contains the names, addresses and phone numbers for each PCP. It also includes Care Choices HMO specialists, hospitals and other health care professionals. These providers are available upon approved authorization from your PCP except for OB/GYN and pediatrician specialists, who can be seen without a referral.

• Women may choose a Care Choices HMO PCP for their general health care needs. This physician can be a Care Choices HMO family physician, general practitioner or an internist. Additionally, women may also receive routine obstetrical and gynecological care from a Care Choices HMO obstetrician or gynecologist. Many PCPs also provide routine gynecological care and some may provide obstetrical care. Please ask your PCP if he or she provides these services.
• Members may choose a Care Choices HMO family physician or a Care Choices HMO pediatrician as their PCP. In addition, your child may see a Care Choices HMO pediatrician for general pediatric care without first seeing his or her PCP for a referral.

Reviewing Important Quality Information

Because the best medical care depends on strong physician-patient relations, we encourage you to take an active role in reviewing important quality information before selecting your PCP. Information available through Care Choices HMO can help you determine critical background information on physicians to ensure your chosen physician meets your care expectations.

When selecting a personal physician, we encourage you to verify information such as:

• Physician's board-certification status:
  Is the physician certified by a review board to practice in his or her area of specialty?
• Physician's hospital affiliation:
  Does the physician practice in a hospital that meets your quality expectations?
• Professional education:
  Where did the physician receive his or her education?
• Practice duration:
  How long has the physician been in a medical practice?
• Method of physician compensation:
  How is the physician paid for his or her services?
• Other consumer satisfaction measures:
  Does the plan have any consumer satisfaction data for the physician? What do your friends or family know about the physician?
• Other quality measures important to you and your family:
  Including language, gender or age.

Our provider directory also includes the following information:

• Provider type (primary care physician, specialist, etc.)
• Specialty
• Hospital affiliations
• Board-certification
• Whether the physician is accepting new patients

Making Your Primary Care Physician Selection

Once you have gathered all the information that you believe is important, please call our Customer Service Department to tell us who you selected as your PCP. If you are not comfortable with your choice after you meet your physician, you have the option of changing your PCP by calling Customer Service. Your new choice will take effect on the first day of the month after you notify us.

For additional information, such as the physician's age, gender, ethnicity, location, degree, board-certification eligibility status and verification of other quality-related physician information, please call Customer Service at (800) 852-9780.

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Verifying Provider Credentials Is An Important Process

Why This Information Is Important For You To Know:

Checking the background data on health care providers will help you validate whether the provider fits your per-sonal needs and has met certain quality standards.

Care Choices HMO has already done a great deal of work to help you by setting specific standards that all physicians must meet to participate in our provider network. When we verify a physician's credentials, we:

• Verify whether the physician has a current, active license in Michigan to practice medicine.
• Learn where the physician went to medical school and received training.
• Learn whether the physician did a residency, the residency specialty and where the residency occurred.
• Learn what hospitals the physician is affiliated with.
• Learn where the physician worked previously.
• Learn the physician's last five-year malpractice history.
• Learn how many patients the physician treats.

Certified Or Eligible?

You may also wish to ask questions about the following credentials when you select a primary care physician or when you are referred to a specialist.

Board certification means that a physician completed several years of specialty medical training (residency and/or fellowship) and passed exams in that field. Exams are designed to ensure that physicians have the knowledge, experience and skill required to provide quality care in a particular medical or surgical specialty.

Board eligible means that a physician passed the written exam but did not take the oral exam. In most cases, "board eligible" reflects knowledge and experience in a particular specialty medical or surgical field.

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Questions You Can Ask About A Provider

You can use the following steps to verify the professional credentials of your personal physician or specialist:

1. Search the provider directory. Our provider directory lists all current participating physicians. Also listed are the physician's address, phone number, languages spoken and hospital affiliation.
2. Contact Care Choices HMO Customer Service. A Customer Service coordinator can answer your questions about the physician.
   • Age.
   • Gender.
   • Medical school.
   • Year of graduation.
   • Board certification or eligibility.
3. Call the physician's office. You may wish to ask:
   • Are you accepting new patients?
   • Are you board certified or board eligible?
   • How long have you been in practice?
   • Do you offer extended evening or weekend hours?
   • What is the procedure for getting after-hours advice?
   • What are your office's on-call arrangements?
   • How quickly, on average, can I get in to see you?
   • Can I get a same-day appointment when I need it?
   • What are your office hours?
   • If you have special language needs, ask the physician's staff what languages the physician speaks.

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