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Insurance Services Programs
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| Five Steps to Patient Safety | FAQ | Glossary |
Altius Health Plans Patient Safety Initiatives
- Patient Safety Officer: The patient safety officer for the members of Altius Health Plans is Dr. Dennis Harston. Dr. Harston is the Vice President of Medical Affairs and reports directly to the President of the company. Critical components of the member safety program include:
- assuring the availability and accessibility to care and service for members
- maintaining an effective provider credentialing program, including the profiling of high volume primary care physicians for member satisfaction, quality of care, and utilization of services
- identifying and correcting risk situations
- measuring member and provider compliance to preventive health care guidelines
- providing case management for high risk, complex, and chronically ill members
- conducting hospital concurrent review to assure that members receive needed services
The broad, overall goal of the patient safety program is to promote the provision of high quality, effective, and cost efficient member care. A multitude of data sources and tools are used to measure the success in maintaining this goal including, in large part, the review of medical record and claims data.
- Drug Utilization Reviews: Altius' Pharmacy Department, in conjunction with Express Scripts, a pharmacy benefit management company, conducts periodic drug utilization reviews including areas such as the use of controlled substances, the treatment of asthma, the treatment of depression, the use of antibiotics, the treatment of diabetes, the treatment of anemia, potential drug-drug interactions, and risks from multiple medications (polypharmacy). Such reviews are intended to identify areas for patient or physician education, promote compliance, or reduce risks.
- Disease Management Programs: Altius strives to actively improve the health status of its members with chronic conditions. This program encompasses identification of members with chronic disease states and offers appropriate services and programs to assist in the management of these conditions. An integrated approach is used to enhance the member's well being. This integrated approach utilizes an identification process based on the epidemiology of the population, development and measurement of clinical practice guidelines for selected diseases, case management of high-risk individuals, ongoing member education about their disease state and the importance of obtaining the recommended care, practitioner education and involvement in disease management, and alignment of resource utilization with benefit structure. Such programs are active for members with the following conditions asthma, diabetes, congestive heart failure, and high risk OB.
- Evidence Based Guidelines: Altius has Preventive Health Guidelines for both adults and children. These guidelines encourage regular medical checkups and indicate the recommended interval for each type of preventive care. These guidelines are actively promoted to both members and physicians. Annual measurement of compliance is conducted and, if needed, interventions are planned to enhance compliance.
The Pharmacy Department has also implemented step therapy programs to promote the use of safer first line drugs before the use by our members of higher cost, higher risk second line agents. Such programs exist in the treatment of pain, acne, anemia, erectile dysfunction, osteoporosis, cancer, allergic rhinitis, depression, and arthritis.
- Profiles: Physician profiles including information on patient satisfaction, complaints, promotion of preventive care, and utilization of medical services are performed annually on high volume primary care physicians. Prescribing profiles are shared in that practice profile as well. Patient specific drug use profiles are shared with prescribing physicians only under limited circumstances, ie. when potential clinical risks exist to the patient.
- Physician Newsletters: The preferred method for communicating with Altius providers is through the Altius website. There is a dedicated portal for providers by which they access a Provider Message Board. Relevant updates are posted on this message board.
- Service and Recognition Program: Altius Health Plans has a program to recognize the top 10 percent of providers who excel at member service and care. Annually those providers are sent a letter signed by executive management recognizing and commending their performance.
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