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Capital District Physicians' Health Plan, Inc. (CDPHP) encourages and actively engages hospitals to support patient safety and share data via initiatives such as LeapFrog. We have provided a link through our web site to the LeapFrog web site, which provides the convenience to members to view the network hospitals that have embraced the LeapFrog initiatives. To further promote physician quality of service, CDPHP offers a Physician Incentive Program that measures physicians' compliance with quality of care indicators. In addition, CDPHP works to optimize patient safety through a number of different mechanisms. A partial listing of these activities includes:

• Thorough practitioner and provider credentialing to ensure a high quality delivery system
• Completion of a site survey to evaluate offices and facilities
• Clinical performance monitors, including measurement of Practice and Preventive Health Guideline to ensure that appropriate care is delivered to all members
• Careful monitoring of continuity and coordination of care, within both the medical delivery system and the behavioral health system, as well as between medical and behavioral health providers
• Pharmacy reviews, including systematic checks for potential drug interactions, drug utilization reviews, and polypharmacy reports
• Claims analysis to detect any trends related to patient safety
• Quality of care referrals

Currently, CDPHP has not designated a specified patient safety officer. However, CDPHP's Quality Enhancement Department works closely with the Resource Coordination to identify specific incidents for investigation and to monitor network performance globally.

An important patient safety effort is in the prescription drug utilization review. We have access to the full prescription drug claims database through the AdvancePCS data warehouse. We often review trends and utilization data for selected therapeutic drug categories. Our on line adjudication system performs many patient safety checks at the point of service and will message the pharmacy, in real time, with pertinent concerns such as potential drug interactions, overutilization, and drug implied disease state concerns. This allows the dispensing pharmacist to have a discussion with the patient, or if necessary, call the prescribing physician even before the new drug is dispensed. At this time, in light of the newest HIPPA regulations, we do not share full patient profiles with prescribing physicians. In instances where concerns may arise we may make phone calls to physicians to discuss our concerns. We have also sought direct specific individual patient consent to provide all records to physicians in cases where this was imperative for appropriate therapy. Retrospective drug utilization review is performed by CDPHP on at least a quarterly basis to ensure formulary compliance, appropriate utilization in drug classes and coordinated pharmaceutical care.

CDPHP values the importance of health management of its members and fosters the goals of its health management programs:

• To reduce unnecessary variations in care, and increase compliance with accepted standards of care (guidelines)
• To continue to develop interventions that result in measurable improvements in member health status
• To reduce disease-associated costs

The current health/disease management programs available to our members include asthma, hypertension, diabetes, depression and ADHD. CDPHP also has CHF and pneumonia programs that focus on the senior population. The common aspects of our health management programs include:

• Adoption/development of practice guidelines - Physician work groups use current literature to adopt/adapt industry standards of care. Guidelines are distributed to practitioners, and compliance is measured annually. Guidelines are updated at least every 2 years.
• Identification of appropriate members - Claims data are used to identify members with these conditions. Members are risk-stratified.
• Education - Educational efforts range from general mailings that may include educational articles featured in CDPHP's member newsletter, SmartMoves, to targeted mailings such as disease specific mailings to members twice a year, to classes and one-on-one educational sessions. Member outreach includes invitation (through newsletter, letter or via telephone) to attend health management education classes. These classes are held throughout the service area, both during the day and in the evening. Alternatively, telephonic education is available, either by speaking directly to an educator, or as a recording.
• Wellness programs - CDPHP promotes healthy lifestyles by offering a wide variety of free wellness programs to members that range from nutrition, stress management, smoking cessation classes, disease specific classes, etc. The quarterly member newsletter, SmartMoves, includes a schedule of the wellness classes offered and members may also view and register for classes at CDPHP's website, www.cdphp.com.