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Healthcare Plan Information

Blue Cross and Blue Shield Service Benefit Plan Patient Safety Initiatives

A Statement from Your Safety Officer

An important goal of the Blue Cross and Blue Shield Service Benefit Plan is to improve the overall health and safety of our members. We strive to provide programs that help members make the right healthcare decisions. Many of the programs described here are voluntary and available at any time to supply Service Benefit Plan members with the resources needed to address health concerns. We are pleased that you are interested in finding out more about these programs.

----Christine Izui, Managing Director, Quality Initiatives

To Your Health

The Service Benefit Plan offers members a website-www.fepblue.org-as the first step in researching their healthcare choices. To Your Health includes sections on Patient Safety, Healthy Families and Health Watch. Within these sections, members can learn about a variety of topics including prescription drug safety, ways to prevent children from smoking and treatment of osteoporosis. In addition, members can use our 2003 Health Links to connect with other websites such as the National Woman's Health Information Center and the American Academy of Pediatrics. Service Benefit Plan members can also link to the Blue Health Connection website, which contains a wealth of health resources, including information on chronic illnesses.

Blue Health Connection

A 24-hour nurse line, Blue Health Connection, helps members evaluate their symptoms and find the right care at the right time. Blue Health Connection also provides members access to health counselors who will answer questions about chronic conditions such as diabetes or about diagnostic tests or surgery options. Using email, the health counselor can answer questions from members directly, online. Blue Health Connection can assist members in finding a doctor or hospital whether they are at home or on vacation. In addition, the Blue Health Connection AudioHealth library allows members access to over 450 recordings on a variety of health topics. Anytime, day or night, members can call Blue Health Connection at 1-888-BLUE-432 or log on to the Blue Health Connection website at www.fepblue.org.

Healthy Families

Healthy Families is an important health education, prevention and safety program for members. Mailings are sent to members one or two times a year, and links to websites are provided for access to useful health information offered by federal agencies. Programs from Healthy Families focus on benefits of preventive medicine, safety tips, preventive screening tests and healthy lifestyle changes. Previous topics have included smoking and your kids, childhood vaccinations, bike safety, flu and pneumonia immunizations and hypertension. The Healthy Families materials increase member awareness of the importance of making healthy lifestyle decisions. In 2003, the focus has been on smoking cessation and physical activity, primarily walking.

Pharmacy Programs

Medication misuse and adverse drug effects are of increasing concern, especially for high-risk patients with multiple chronic conditions and drug therapies. The Service Benefit Plan has implemented several strategies to address these issues.

  • Safety Checks - Before a member's prescription is filled, the Service Benefit Program has put in place safety and quality checks to provide information to the pharmacist about precautions or contraindications related to other drugs a member may be taking and that person's age and sex. These checks can help identify instances of drug duplication, excessive dosage, or inappropriate duration of therapy.
  • Pharmacy Patient Safety and Quality Monitoring - To improve the overall health and safety of our members, we have implemented the Patient Safety & Quality Monitoring (PSQM) program for the Retail and the Mail Service Prescription Drug programs. Developed by physicians and pharmacists, the PSQM program ensures that members receive safe and appropriate quantities of medication. Through the PSQM program, we require prior approval before certain prescription drugs are covered. This process helps to assure that drugs are used where they are most effective, preventing unnecessary risks of adverse effects. Limited quantity allowances are in place for certain drugs, again, to prevent exposure to unnecessary risk. These allowances are based on guidelines approved by the U.S. Food and Drug Administration and generally accepted medical practice.

Care Management Programs

The Service Benefit Plan offers programs to help members manage their health. Depending on where the member lives, local health care management programs may be available to manage chronic conditions such as diabetes. Local health care management programs support the member's relationship with his or her doctor. These programs are designed to improve the member's health and quality of life. We encourage members to use these programs. They can contact their local Blue Cross and Blue Shield Plan to find out what programs are available.

Case Management

Opportunities for members' access to quality and safe care is enhanced and promoted through the case management process. Case management involves the evaluation of an individual's health needs. This is achieved through diverse, innovative and integrated management of care episodes utilizing the Service Benefit Plan benefits and community based resources and organizations. Members can receive medically appropriate and cost-effective alternatives to traditional care. Case management is administered through the Flexible Benefits Option.

In July 2002, the Service Benefit Plan was awarded full URAC Case Management Accreditation- the highest accreditation rating possible. Achieving accreditation demonstrates a commitment to the delivery of consistent, high-quality healthcare to our members. The accreditation is the first System-wide accreditation within Blue Cross and Blue Shield.

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