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Health Net is encouraged by the Federal Employee Health Benefit Program's focus on new approaches to improve patient safety. We are committed to patient safety initiatives to prevent and reduce medical errors. A focus on patient safety goes hand in hand with Health Net's philosophy of being a “gateway” provider of quality healthcare benefits for our members. Information on some of Health Net's Patient Safety Initiatives is designed to provide you with information to help you live your healthiest life possible.

Commitment to the LeapFrog Group's Patient Safety Initiatives

Health Net strongly supports Leapfrog through the following activities:

• Member of the LeapFrog Group, as an employer, since August 2002
• Committed to increasing hospital participation by commitment from Health Net's Chief Executive Officer and Chief Medical Officer to strongly encourage that contracted hospitals comply with the LeapFrog standards.
• Includes Leapfrog and other Patient Safety information included in member and physician newsletters and flyers as well as the Healthnet.com/FEHBP web site.
• Provides a link to the LeapFrog web site from Healthnet.com/FEHBP.
• Health Net will compile the results of the LeapFrog survey annually to report on the level of hospital compliance within our network.

Pharmacy Programs

Health Net incorporates the following clinical pharmacy initiatives, focused on quality care and patient safety into its pharmacy program:

Electronic Monitoring to Ensure Safety - Health Net's pharmacy system reviews every prescription processed by Health Net contracted pharmacies to ensure member safety as follows:

• Informs the pharmacy of any drug to drug interactions;
• Lets the pharmacy know if a similar prescription in the same therapeutic class or includes the same ingredient has been processed within the same time frame of the current prescription;
• The system will communicate to the pharmacy that the prescribed dose range for pediatric or geriatric patients and/or the duration of therapy is below or above usual range;
• Informs the pharmacy that the prescribed medication is not approved for the patient's age;
• Will notify the pharmacy that the prescription is being refilled earlier than indicated on the prescription.

These system checks are done regardless of which pharmacy or physician the patient uses. The pharmacist is advised by an electronic message to notify the patient's physician and obtain the physician's approval prior to completing the prescription. This way the patient is assured that their physician is aware of the risks and possible dangers of the prescribed medication.

Narcotic Analgesic Program - Managing over-utilization of narcotic analgesics is a major challenge for health care providers. Health Net implemented measures for OxyContin and MS Contin such as requiring prior authorization for prescriptions requesting more than 3 tablets per day, mail-order pharmacy is not available and the physician must submit a pain management plan. These measures do not apply to prescriptions from oncologists and hematologists for treatment of cancer.

Annual Antibiotic Initiative - The annual antibiotic initiative consists of a provider education brochure entitled “Guide to Appropriate Anti-Infective Usage.” The main goal of the education initiative is to encourage the appropriate use of antibiotics and to discourage their use when not indicated (e.g., viral infection) so as to prevent the formation of antibiotic resistance. The second goal is to encourge the use of annual flu vaccination to prevent this troublesome and sometimes deadly illness, especially in those at higher risk for complications.

Disease Management Programs

Health Net provides Disease Management Programs for members with persistent asthma, congestive heart failure (CHF), diabetes, and coronary artery disease (CAD). These programs deliver interventions to more than 100,000 members with chronic disease, including: 1) mailings to members with chronic conditions with information about the condition, where to find additional information on the Health Net web site and access to an evidence based medicine screening and treatment guidelines.

These multi-dimensional programs were designed to complement the care provided by the Primary Care Physician and to help members manage their health more effectively. Health Net Primary Care Physicians and Participating Medical Groups receive information about each of the Disease Management Programs, including summary clinical practice guidelines, condition-specific information and lists containing their members with possible chronic conditions.

In July 2002, Health Net launched a practitioner-based depression program in partnership with the USC School of Pharmacy. This program notifies PCPs by monthly mailings of: 1) their patients initiating pharmaceutical treatment for new episodes of depression and 2) the status of drug therapy for these patients for the first six months of treatment. In September, 2003, Health Net is expanding the program to include educational mailings to members initiating antidepressant therapy with information about depression and the importance of adhering to prescribed medication therapy.

These disease management programs build on milestones Health Net has already achieved based on the principle that the best patient safety strategy is a fully informed consumer. To this end we have:

• Partnered with EBM Solutions which provides 120 evidence based clinical and treatment guidelines on their website (www.EBMSolutions.com), in both clinical and member language, available to our physicians and members through a link on HealthNet.com
• Implemented the Medical Group Comparison Report, an online tool that allows Health Net members to compare Participating Medical Groups based on the quality of care and service the medical groups provide in Managing Chronic Illness, Access to Care, Member Satisfaction, Prescribing Practice.
• Implemented the on-line Hospital Comparison Report that includes results of the LeapFrog survey for all Health Net contracted hospitals as well as comparable data from OSHPD for hospitals that have not responded to the survey

Health Net has had a quality of care incentive program (QCIP) in place for 10 years. The QCIP rewards Participating Medical Groups for excellence in quality care and service to members. This partnership between Health Net and network medical groups promotes better health and more positive interactions with the health care system for members.

Starting in 2003, Health Net is joining with the five other major health plans in California to implement a joint Pay for Performance program under the aegis of the Integrated Healthcare Association. This program has defined a common set of clinical and service metrics to be used by the participating health plans. Medical Groups that also have an incentive program that pays their individual physicians for quality performance will earn an additional bonus.

Lastly, Health Net is in the process of forming a partnership with a company that assists patients with issues across the entire spectrum of health care. The program includes the management of chronic conditions, significant medical conditions and symptom management for minor medical events through the use of health coaches telephone support as well as world class evidence based video, Web and printed materials. Watch for our announcement this fall.