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Blue Cross of California's continued efforts to improve health care quality and member satisfaction include the patient safety related measures outlined below. Dr. Jeff Kamil, vice president and medical director for Blue Cross of California, oversees Blue Cross of California patient safety initiatives.

Patient Safety

Blue Cross of California is very supportive of the Leapfrog Group's efforts to promote patient safety. In California, the Pacific Business Group on Health (PBGH) is championing this effort. Blue Cross of California's corporate medical director is a member of the PBGH Medical Advisory Committee. We encourage hospitals to complete the Leapfrog survey, and we contact key Blue Cross contracted hospitals that do not comply. Leapfrog recommended safety measures include:

• Computerized physician order entry (CPOE)
• Additional physician staffing for intensive care units
• Reported volume/outcomes measurement for selected procedures

Results of the California hospital survey are available at www.healthscope.org; information for all regions is available at www.leapfroggroup.org.

Blue Cross has developed a coronary artery bypass grafting (CABG) Centers of Expertise (COE) hospital network consisting of 70 hospitals. BCC will begin building member incentives to encourage members to use the CABG COE in 2004. BCC utilized Leapfrog standards to develop the CABG COE Program and has plans to roll out other COE programs using Leapfrog standards over the next two to three years

HEALTH IMPROVEMENT (Disease Management) Programs

Blue Cross of California's Health Improvement Programs (HIPs) provide an innovative interdisciplinary approach to helping members manage asthma, congestive heart failure, and diabetes. Members work with a team of health care professionals - led by a registered nurse acting as a “health coach” and including their personal physicians - to achieve health and lifestyle goals. We also offer Baby Connection, our high-risk pregnancy program.

In late 2003 and early 2004 we will be expanding our HIPs. Our Congestive Heart Failure program will be enhanced to include components that address cadriovascular disease, hypertension, high cholesterol, coronary artery disease and stroke. Our Baby Connection program will be converted into a National Perinatal program to address pregnancy from conception through the first 18 years of life, to include a component for postpartum depression. Additional programs that will be implemented in early 2004 include a Musculoskeletal program that will address rheumatoid arthritis, osteoarthritis and low back pain. We will also be implementing an Oncology Support program in early 2004.

Centers of Expertise for Transplantation

Blue Cross recognizes facilities that have distinguished records for highly specialized organ transplants with established programs for heart, lung, heart-lung, liver, simultaneous pancreas-kidney and bone marrow transplantation.

guidelines for treatment recommendations

Blue Cross of California adopts guidelines that are evidence-based and endorsed by national specialty societies or associations such as the National Diabetes Association, U.S. Preventive Health Services Task Force, and the American Academy of Pediatrics. Guidelines are reviewed prior to approval and implementation by an expert panel of physicians convened by Blue Cross.

Blue Cross of California provides several programs designed to ensure safe and appropriate medication use. Included are programs that focus on members with high pharmacy utilization, pharmacy issues in the senior population, migraine management, asthma management, and the appropriate use of antibiotics.

Drug Utilization Review

Our standard drug utilization review program integrates prospective, concurrent and retrospective analysis to create an effective force enhancing the safety, appropriateness, and cost effective use of pharmaceuticals. Prospective review encourages selection of a cost-effective, therapeutically efficacious medication at the point of prescribing. Our on-line system provides pharmacists with concurrent review capabilities, referencing member pharmacy claims history and indicating potential drug interaction information and formulary therapeutic recommendations. Retrospective review uses drug utilization data gathered from our database to target patients, physicians, and pharmacists who are non-compliant with formulary and other clinical programs.

PCP Notification Program

Under the primary care physician (PCP) notification program, PCPs receive a list of their Blue Cross patients who have chronic diseases and are taking psychotropic medications prescribed by a psychiatrist. In addition our pharmacy system includes features designed to prevent adverse drug interactions.

physician and hospital quality

PMGs/IPAs

Blue Cross of California evaluates its contracted PMGs and IPAs annually. Results are reported in performance profiles that are available to members on our Web site. Blue Cross offers a quality incentive bonus to health care providers based upon performance profile report results.

Blue Cross monitors hospital quality performance through a contract with Subimo. Detailed hospital quality performance is provided to members on our Web site. Subimo's knowledge base integrates diagnosis and procedure information with hospital data from state and federal agencies such as quality reports from the Pacific Business Group on Health and the Office of Statewide Health Planning Development. Profiles consist of the following:

• Volume of major surgical procedures
• Complication rates
• patient satisfaction results

Members have the advantage of readily available information - from respected and reliable sources - to help them make informed decisions about procedures or treatments.

newsletters

Blue Cross addresses patient safety in physician, member, and hospital newsletters and on our Web site.