GVHP QUALITY PROGRAM

GVHP believes in quality. We believe quality should be part of our health care delivery. We also believe it should be part of the service we offer our members. GVHP shows quality. Here are a few ways we do this.

GVHP goes through an accreditation process. This means we must go through a thorough review process. Some managed care organizations choose to go through this process to demonstrate quality. The National Committee on Quality Assurance (NCQA) is a nationally recognized organization. NCQA “gives a seal of approval”. GVHP has gone “under the microscope," so to speak. This is one way we can demonstrate quality. We are also authorized by the Office of Financial and Insurance Regulation (OFIR) and the Michigan Department of Community Health (MDCH). We report regularly to them about our quality, service and other measures. GVHP must meet OFIR standards on a regular basis.

GVHP also has a Quality Program. This program is measured. Annually, we report the results to our Board of Directors. We give this information to OFIR and to MDCH.. You may also review our annual Quality Program evaluation.

For more information or a copy of the GVHP Quality Program, call the GVHP Customer Service Team at 616-949-2410 or 800-335-1977

OTHER SOURCES OF INFORMATION ABOUT GVHP

Where can you learn more about GVHP? GVHP believes it is important for members and customers to have information about GVHP. We give our members information on a regular basis. We also give information to our providers. Here are some ways we regularly “talk to” you.

We publish a member newsletter. Practitioners also receive a copy. The newsletter provides current information about healthy living. Also upcoming GVHP events, health education classes and general plan information. We do this when we want to share new or important information.

GVHP would like to encourage you to visit our website for informational links. The web address is: www.gvhp.com. Now available for review on-line:

• MIChild Member Handbook
• GVHP Notice of Privacy Practices
• GVHP Notice of Privacy Practices
• Member Rights and Responsibilities
• Also available on-line are basics on how to access care and other facts.

You can also find on the GVHP website pictures and maps to each of our six area Family Health Center locations. Click on “contact us” to e-mail your comments or suggestions directly to GVHP.

For any and all questions, you can always call your GVHP Family Health Center. Or, you may call the GVHP Customer Service Team at 616-949-2410 or 800-335-1977.

FREQUENTLY ASKED QUESTIONS

How do I choose a GVHP Family Health Center?

GVHP has several GVHP Family Health Centers. They are conveniently located. All are within a 30 minute drive from most homes as well as acute hospitals within the GVHP service area. You may choose a GVHP Family Health Center closest to where you live or where you work. The choice is yours. Whichever GVHP Family Health Center you choose, you will get a complete GVHP Family Health Center Team. (For more information, see GVHP’s Team Approach to Health Care in your handbook.)

How do I use my GVHP Family Health Center?

You can use your GVHP Family Health Center for:

• Routine care – simply call and make an appointment
• Urgent care – even after hours, call your GVHP Family Health Center
• Even in an emergency, if time permits, you can call your GVHP Family Health Center
• 24 hours a day coverage, 7 days a week

For more information, see GVHP Family Health Center Hours and After Hours Care in your handbook.

How do I change my GVHP Family Health Center?

Simply choose from the other GVHP Family Health Centers. You may complete a GVHP Family Health Center Transfer Form. You can do this right at your current GVHP Family Health Center. Or, you may call the GVHP Customer Service Team at 616-949-2410 or 800-335-1977 to request a change form.

How do I establish a relationship with my GVHP Family Health Center Team?

Call your GVHP Family Health Center and arrange for a tour. This will give you the chance to see the office and meet the people who will be caring for you. At that time, we can help you arrange to transfer any records from your previous doctor. As you continue with your care, become involved. Ask questions. Listen carefully to the information. Keep true to your treatment plan. Have any questions or concerns? Talk to your team.

If I have lost or misplaced my ID card how can I receive a new one?

If for any reason you need a new ID card, just ask your GVHP Family Health Center. Or, you may call GVHP Customer Service Team at 616-949-2410 or 800-335-1977. We will be happy to help you with your request.

Should I tell GVHP if I ever have other health insurance?

Always let us know that you have other coverage. This helps us coordinate benefits with your other plan. When you come for a visit, the Patient Care Coordinator will ask you at check-in for this information. Or, you can call your GVHP Customer Service Team at 616-949-2410 or 800-335-1977.

Should I notify GVHP if I change my address?

Yes, let us know as soon as possible. We do not want you to miss learning about important information. Your current address helps us stay in touch with you. Just let your GVHP Family Health Center know of this address change at your next visit. Or, simply call your GVHP Customer Service Team at 616-949-2410 or 800-335-1977.

How do I arrange a visit to a specialist?

Your GVHP Family Health Center Practitioner treats you for most of your needs. This ranges from common cold and allergy treatments to setting broken bones and diagnosing more complicated health care problems. Your GVHP Family Health Center Practitioner might determine that another practitioner would more appropriately handle your treatment. You will then receive a referral to a specialist. A referral is usually valid for only one appointment. If more care is needed, contact your GVHP Family Health Center for authorization. Be assured that your GVHP Family Health Center will continue to monitor your care with the specialist.

What do I do in case of an emergency?

If you need urgent care for a non-life threatening emergency, like a sprain, earache, or high fever, call your GVHP Family Health Center. Your GVHP Family Health Center is available 24 hours a day, 7 days a week to help you with your medical needs. Your GVHP Family Health Center will arrange your “urgent care” needs.

If the emergency is life-threatening, examples are a suspected heart attack, stroke, poisoning, call 911 or go directly to the nearest emergency room. Do call your GVHP Family Health Center when medically reasonable (within 48 hours is best) to let us know what happened to you. Your GVHP Family Health Center will arrange your follow up care.

For more information, see Urgent Care and Emergency Care in your handbook.

What happens if I get sick on vacation and am not near my GVHP Family Health Center or Grand Valley Health Plan’s service area?

You are always covered for emergency or urgent care no matter where you are. If your condition is urgent (not life-threatening). You must still call your GVHP Family Health Center to get approval for an urgent care visit. If you are out-of-area, you may always call collect. If your condition is an emergency (life-threatening), go to the nearest hospital. Call your GVHP Family Health Center when medically possible. Let them know what happened.

Are there any restrictions on benefits if I get services outside Grand Valley Health Plan’s service area or health care delivery system?

GVHP is not an insurance company but a health care delivery system, which operates on a direct service basis. If you obtain services outside of the GVHP service area and these services are not authorized the services are not a covered benefit. You cannot be reimbursed for these services. This restriction does not apply to emergency care.

What happens if I need to be hospitalized?

Your GVHP Family Health Center is always your first point of contact. Your GVHP Family Health Center can help you with what you need to get into the hospital. Your GVHP Family Health Center will also arrange or help with any tests or special treatment you may need.

How do I file a complaint?

Give your GVHP Family Health Center a call. Discuss your concerns. If you are not satisfied call the GVHP Customer Service Team at 616-949-2410 or 800-335-1977. Also, MEMBER COMPLAINTS in this handbook.

What if I am dissatisfied with the decision made about my complaint (or claim that has been denied)?

You have the right to file a grievance. Call the GVHP Customer Service Team at 616-949-2410 or 800-335-1977 for grievance information. Also, see MEMBER GRIEVANCE in this handbook.

CLOSING THOUGHTS

We would like to close this handbook with some thoughts about “managed care.”

“Managed care” is a term that means different things to different people. We want to tell you what “managed care” means to us. We know that while “managed care” sets out to lower health care costs, it does this by keeping you healthy and out of the hospital. That’s good! The quality of your life – good physical and mental health – is important! So, we know that managed care also assures that “quality” stays in the “care” you are given. That’s good too! Balancing cost and quality while “delivering” care is the aim of a managed care organization. We at GVHP make these our goals.

GVHP is a health plan - not just an insurance program. We deliver care through an integrated delivery system. This system provides you with almost every aspect of health care you may need. By staying within this “delivery” system, you can get the greatest benefits. This means you need to work closely with your GVHP Family Health Center team. They will manage, coordinate and provide your health care.

Thank you for choosing GVHP as your healthcare partner!