Click here to skip navigation
This website uses features which update page content based on user actions. If you are using assistive technology to view web content, please ensure your settings allow for the page content to update after initial load (this is sometimes called "forms mode"). Additionally, if you are using assistive technology and would like to be notified of items via alert boxes, please follow this link to enable alert boxes for your session profile.
An official website of the United States Government.
Skip Navigation

In This Section

Healthcare Plan Information

Patient Safety Initiatives

Dear Federal Employees Health Benefits Program Participant:

The Special Agents Mutual Benefit Association (SAMBA) appreciates this opportunity to share the measures we have implemented related to patient safety initiatives, programs, and general health information to assist our members enrolled under the SAMBA HEALTH BENEFIT PLAN.

SAMBA understands the importance of patient safety and quality initiatives regarding our nation's health care systems and therefore, has undertaken - in collaboration with our partners - the following efforts to assist in insuring the safety and well being of our members.

Disease Management Programs

SAMBA has in place Disease Management (DM) Programs that systematically identifies members with chronic conditions relevant to the Plan's population. The programs are designed to obtain the best possible health outcomes, provide access to care for members, ensure that high quality care is being delivered, and control health care cost. The DM Program is a comprehensive, integrated, and targeted approach to care for members with selected chronic or life-threatening diseases in the areas of asthma, diabetes, cardiovascular disease, and cancer. The DM programs are designed to help members manage these diseases and improve their quality of life by offering educational information, personal support, and coordinating of care with providers. Components of the DM program range from disease-specific informational pamphlets to telephonic case management and/or home health programs depending on the member's level of need. The DM programs also serve to strengthen the provider-patient relationship by making it easier for the provider to monitor the patient and by supplying the patient with necessary self-management tools.

Prescription Drug Manager Programs

Quality is the cornerstone of the Plan's Prescription Drug Manager's (PBM) mail service pharmacies; designed to combine the best in modern technology with the skill of experienced and expertly trained pharmacy professionals. Specially designed, sophisticated dispensing and computer systems help their pharmacists and technicians fill each prescription accurately and efficiently. All mail service pharmacies have a formal quality assurance process to promote active error prevention and conform to federal and state regulations related to retail and mail pharmacies. A few of the quality assurance programs our PBM currently has in place are:

Concurrent Drug Utilization Review (DUR): Utilizing innovative information technology to proactively warn the dispensing pharmacist of potential drug misadventures the DUR program operates in an on-line, real-time environment. This "real-time" intervention in patient care enables the PBM to prevent adverse reactions, improve appropriate prescribing rates and accurately enforce SAMBA's administrative rules. Their Clinical Decision Support System SM (CDSS) checks all incoming prescriptions to prevent the patient from experiencing inappropriate drug prescribing or consumption, medical conflicts or potentially dangerous interactions. For concurrent interventions, our PBM relies on the professional judgment of both retail and mail service pharmacists to determine the appropriate intervention with the patient and/or prescriber for resolution of any clinical issues.

Retrospective Drug Utilization Review (DUR): Our PBM has extensive clinical experience in identifying inappropriate patterns of care through the retrospective review of patient claims histories. The Retrospective DUR Program concentrates on evaluating the entire patient population for inappropriate utilization. This review maximizes the clinical and financial impact on SAMBA's prescription drug benefit. Retrospective DUR identifies prescribing, dispensing, and consumption patterns which are clinically and therapeutically inappropriate and do not meet the established clinical practice guidelines. Physician interventions are then used to correct aberrant behaviors.

Drug Recalls/Drug Product Removals: Our PBM monitors and communicates many actions of the FDA and Drug Manufacturers, going beyond standard drug recall and drug product removal. This monitoring includes Drug Recalls, Market Withdrawals, Product Discontinuation and Significant Prescribing Information Changes. Any activity that is noted in these key areas will require an internal review and a plan from their Corporate Recall Committee within 24 hours of notification. The responsibilities of the committee are operationally focused on protecting the mail-service patient from continued use of potentially harmful drugs. Also, they post informational messages to systematically alert network retail pharmacist - at point of sale - that the product is recalled should they attempt to fill one of these prescriptions.

Quality Initiatives

The Plan has an array of quality initiatives in place that range from an interactive website and patient education to meeting accreditation standards.

Online Resource: Every effort is made to make the SAMBA website - located at www.SambaPlans.com - a premier source for patient education. SAMBA believes that the Internet, as a communications and resource tool, can be a valuable complement to information regarding a patient's health care. Our interactive site provides members access to their claim history, personalized pharmacy benefit management services with prescription medication refill ordering capabilities, health and wellness information designed to assist our members in becoming more knowledgeable about their health care consumer education, and much more.

Consumer Education: Aside from the web-based tools available for the patient to obtain information on health care, patient safety and quality related information about specific network hospitals, SAMBA promotes access to a telephonic Health Resource Line. Operated by nurse advisors, the Health Resource Line is available 24-hours a day, 7-days a week to answer general medical questions, provide education materials, and assist our members in making health care decisions.

Accreditation: Committed to working with our members and their physicians to improve the quality of clinical care and service, our associates strive to earn and/or maintain full accreditation for the Plan's clinical management programs and provider networks. Accreditation is awarded through widely recognized health accreditation organizations such as URAC, assuring that they meet or exceed the nationally established standards for the health care industry.

SAMBA knows it contributes and makes a difference with reducing medical errors and increasing patient safety for our members by adhering to the high standards expected from all Plan's participating in the Federal Employees Health Benefits Program.

Control Panel