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Healthcare Plan Information

APWU Health Plan Patient Safety Initiatives

At the APWU Health Plan, we are aware that you, as Federal consumers, are at the center of health care decisions. Therefore, we want you to know that we are continually striving to put programs in place that will enhance your safety as a healthcare consumer.

The Health Plan has a patient safety officer who works in the Care Management Department of the Health Plan. In this capacity, the patient safety officer works closely with our Preferred Provider Networks (PPO) and Pharmacy Benefit Manager, Express Scripts, in order to monitor existing and new programs designed to promote patient safety. The patient safety officer also works with the Health Plan's Member Education Department on articles for our member newsletters and on information for our website, designed specifically to increase your knowledge about how to keep yourself and your family safe while navigating the healthcare system.

The APWU Health Plan has two benefit options for you to choose from: the High Option and the Consumer Driven Option. So, we would like to tell you about the patient safety initiatives we have in place for both of these options.

We want FEHB Program High Option Consumers to know that:

  • The APWU Health Plan provides you with information on safety, prevention and making sound health choices in both print and on the APWU Health Plan's website. Examples of this type of information are:
    • Articles in The HealthConnection, the quarterly membership newsletter, on topics such as tips on talking to doctors and preventing medical errors, and an entire issue dedicated to healthy lifestyles.
    • A series of articles promoting healthy lifestyles through prevention have been included in APWU and affiliate publications.
    • APWU Health Plan's website includes a section on Tips on Healthcare and Patient Safety with links to other helpful sites. This section includes information on preventing medical errors and preventing errors with prescription medications. It also contains a link to the Agency for Healthcare Research and Quality (AHRQ) that includes information on preventing medical errors.
    • The website also has a link to the WebMD hospital quality guide. Members can compare hospitals based on specific procedures, survival rates, complication rates, and recovery rates. Hospital data is also available regarding responses to the Leapfrog Group Survey on patient safety. All of this information helps our members make informed medical consumer decisions.
    • A link to ValueOptions' Achieve Solutions website-provides valuable resource information and support for our members on topics related to safety.
  • You have access to a 24/7 Health Information Line, which answers your questions about treatment options, such as whether or not it would be appropriate to seek treatment in an emergency room or what a procedure entails. At your request, the Health Information Line, will send you brochures on various medical topics. They also send out quarterly newsletters and postcards discussing various topics of interest.
  • You have access to the Cigna PPO network and various regional networks contracted by Cigna and VIEquicare in the Virgin Islands.Providersand hospitals are credentialed based on standardized criteria, which also serves as a safety mechanism for you. The network as well as the Utilization Review/Case Management and Behavioral Health vendor are either NCQA or URAC Accredited. Numerous hospitals within the network participate in the Leapfrog Initiative, which is a national study on patient safety.
  • The APWU Health Plan and Express Scripts, our Pharmacy Benefit Manager (PBM), has several programs in place that promote patient safety. One of those programs is RationalMed. The goal of the program is to reduce illnesses and hospitalizations due to incorrect dosages, incompatible combinations of medications, misuse of medications or unneeded treatments. We offer our members pharmacogenomic testing prior to taking two drugs, Warfarin and Plavix, in order to determine correct dosing and potentially prevent complications. UHC also has concurrent and retrospective programs that monitor drug usage, thereby helping to prevent prescription drug errors. When necessary to prevent a possible safety issue, Express Scripts will share drug profiles with the patient's doctors.
  • The Health Plan has Disease Management and Health Management programs that address chronic disease states such as Diabetes, Cardiac disease and Hypertension. The objectives of these programs are to educate and empower our members and assist the member in navigating through the healthcare system. A potential participant should expect to receive a letter of introduction, an initial contact phone call and ongoing contact with a clinician. Based on your agreement to participate, the Care Counselor may contact your doctors in order to share pertinent medical and prescription drug profile information. They may also issue evidence-based guidelines to your doctors in order to assist with treatment recommendations. The Health Plan continues to o provide decision support for high tech diagnostic imaging, such as PET Scans, CT Scans and MRI's. The goal of this radiology management program is to ensure that patients receive the best possible imaging exam for their condition, preventing unnecessary exposure.

APWU Health Plan's Goal
The Health Plan's goal is to provide you with the information you need to be good consumers. We want to encourage you to be proactive, as you access needed healthcare. The goal of the information we make available, whether on the website, in print media or via the Health Information Line is to provide you with the information you need to make good decisions. We want you to realize that you need to take responsibility for yourself. You need to be knowledgeable; to ask questions; to write things down; to share pertinent medical information with your provider, and to have a family member or friend act as your patient advocate if you are unable to do it on your own. The overall goal is to encourage you to be proactive and informed about your healthcare. The expected outcome is much the same; that you will feel more in charge of your healthcare because you are more knowledgeable.

Evaluating Results
The Health Plan has input into questions that are asked by our Health Information Line when they conduct their annual member satisfaction survey. Some of the questions ask whether the information you received in reference to your care helped you make an appropriate, safe, healthcare decision. In 2012, the Health Plan will also receive data from Express Scripts. The data will enable the Plan to evaluate how our pharmacy programs helped to avoid drug errors/interactions and how the programs potentially decreased the need for care, which would otherwise have been necessary without intervention of the Medco programs.

We want FEHB Program Consumer-driven Option Consumers to know that:

United HealthCare (UHC) administers the APWU Health Plan's Consumer-driven Option. When you enroll in the Consumer-driven Option, you will have access to the Personal Care Support program, which is managed by UHC’s Medical Director.

  • The Personal Care Support program promotes patient safety and the reduction of medical errors by:
    • Analyzing pharmacy and medical claims on a monthly basis in order to identify if you have a chronic condition, such as Diabetes, Coronary Artery Disease or High Blood Pressure. If the analysis shows that a diabetic patient hasn't had an evidence-based, recommended blood test (HgbA1C) in three months, the Care Support team will make a phone call, send mailings and/or email a notice to the member recommending that they have this test done, and give them the reasoning for the test. They do this in order to engage you, the patient, in getting involved and educated about your disease process. Also, at appropriate ages, UHC will send out information recommending that you have certain preventive tests done. If you call UHC to notify them that you are going to have a surgical procedure, their health coaches can help you determine if there is a less invasive and possibly safer treatment option available.
    • Publishing hospital quality information (where available), including information about services associated with better patient outcomes such as Computerized Physician Order Entry systems, full time critical care physician staffing, and surgical procedure volume for common major procedures.
  • A key component of the UHC Patient Safety program is their Health Coaching service. Health Coaches are available 24-hours a day to provide you with decision support and disease management services to ensure that you receive the appropriate care. The Coaches provide support for a vast array of conditions, including in-depth programs for members with chronic diseases such as Diabetes, Asthma, Chronic Obstructive Lung Disease and Coronary Artery Disease.
  • UHC's decision support services are designed to encourage you to collaborate with your physicians in order to make the best treatment-selection decisions possible. Their support services can educate and coach you on such topics as medical error prevention; risk factor reduction; medication compliance, contraindications and interactions; and informed medical decision-making. For example, if you call and tell UHC that you are having a certain surgical procedure; they can help you determine if a less invasive, possibly safer treatment option is available. On average, these services have been shown to reduce the rate of unnecessary surgery by 30%. Unnecessary surgery is a significant factor driving poor quality care and medical errors, so this is a very helpful tool.

Members who may especially benefit from these decision support services include, but are not limited to, the following conditions:

  • Breast cancer: lumpectomy and radiation vs. mastectomy
  • Low back surgery
  • Arthritis and lower extremity joint replacement
  • Prostate cancer surgery
  • Coronary artery disease treatment and bypass graft surgery
  • of life treatment
  • Hysterectomy for benign uterine conditions

UHC and Express Scripts, our Pharmacy Benefit Manager (PBM), has several programs in place that promote patient safety. The goals of the programs are to reduce illnesses and hospitalizations due to incorrect dosages, incompatible combinations of medications, misuse of medications or unneeded treatments. Express Scripts also has concurrent and retrospective programs that monitor drug usage, thereby helping to prevent prescription drug errors. When necessary to prevent a possible safety issue, Medco will share drug profiles with the patient's doctors.

UHC strongly believes that member-focused programs are the most effective way to promote medical error reduction. Using web based tools and customer service; you have the opportunity to review physician and hospital quality. These tools provide you with an additional opportunity to become more knowledgeable and make wise healthcare decisions.

UHC's Goal
UHC’s goal in providing patient safety support for you is to reduce the rate of medical errors while continuing to improve member satisfaction. UHC believes that the most effective way to achieve this goal is to educate you by providing you with clinically proven outcomes so that you can work together with your physicians to ensure that you are making sound medical decisions.

Evaluating Results
UHC consistently monitors their programs in order to ensure on-going success and future effectiveness. This is performed by tracking member usage of the website with regards to the use of patient safety web tools and information sources. UHC conducts and reviews member satisfaction surveys focusing on their Health Coaching and Personal Care Support services, including the Patient Safety program. UHC also analyzes claims data to determine if the program decreased the need for care, which would otherwise have been necessary without their intervention.

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