NALC

Patient Safety Initiatives

NALC Health Benefit Plan (Enrollment codes 321/322)

Your choice for quality care, patient safety and comprehensive benefits!

NALC Plan clinical and educational services enhance patient safety by focusing on outcomes for overall wellness in many NALC programs including disease management, prescription drug care, and managed behavioral health.These programs serve to educate our members about patient safety and bring an increased level of awareness when members participate in the quality of care that improves one's quality of life. Programs are co-managed by our professional and clinical partners: First Health’s managed care services for Hospital Utilization Review, Organ Transplant and Case Management programs, Caremark’s Pharmaceutical programs for disease and drug management, with utilization and clinical safety edits to ensure proper drug regimens, and United Behavioral Health’s Managed Mental and Behavioral Healthcare Network that works with patients and doctors to foster improved patient outcomes. Each program is proactive, patient focused and outcome oriented with safety and care as its primary goal.

How does it work?

First and foremost is the need for active member participation in their medical care needs. Working with the Plan and its programs will inherently provide members with added safety measures and promote better clinical outcomes as well as receive higher level of claim benefits. Through these important program managers, the NALC Plan strengthens its safety measures in drug utilization reviews, network error reporting, network credentialing, care management programs, and surveying existing members and providers of mental health and Medical PPOs.

Drug Utilization Reviews

As our pharmaceutical benefit manager, Caremark intensifies the safety and control of drug therapy. All pharmacy claims data is integrated in a single, company-wide, real-time technology platform. This allows Caremark to review each flagged prescription to see the full picture of a member’s drug utilization and potential inappropriate or harmful therapy patterns. The Plan and Caremark also evaluates long-term drug history, retrospective analysis, to identify risk for drug interactions of drug-induced diseases. The analysis identifies opportunities to reduce unnecessary prescriptions or to simplify member’s therapy. A safety letter is sent to the prescribing physician along with the member’s 12-month prescription profile to alert the doctor to evaluate his treatment program. This information not only provides the doctor with the most appropriate clinical alternative available, but it is also educational.

Disease Management

Managing a disease requires coordination between physician, pharmacist, and patient. Caremark’s CarePatterns Disease Management Programs are designed to educate participants on topics related to their specific condition, comply with their physician’s treatment plans and assist the patient in making lifestyle changes that will help them better manage their chronic condition. The programs include management of Ulcers, Diabetes, Asthma, Chronic Heart Failure, Coronary Artery Disease, and Chronic Obstructive Pulmonary Disease. When voluntary enrollment is elected, participants receive written educational material on their disease state, one-on-one telephonic contact with CareNurses (registered nurses) to follow-up and help reinforce the education process, and on-line access to a web site for review of a variety of topics.

Managed Behavioral Health

United Behavioral Health (UBH) identifies and provides a specialized Care Management Advocacy Program for intensive cases on members at high risk for hospitalizations or high utilizers of behavioral health services. Care management programs,such as substance abuse, history of suicide attempts, violence, or impairment in job relations, help to maintain members in the treatment setting that is the least disruptive to their daily lives and reduces unnecessary hospitalizations while concentrating on improved member health outcomes.

Hospital Utilization/Transplant Programs/Case Management

When the complexity of hospital care, the need for organ donations and transplants, or the need for sensitive and caring handling for clinical case management - the NALC Plan partners with First Health to meet those needs for its members. Daily contact, meeting sensitive needs of patients and working with providers of care collectively, ensures that a safety and clinical care net is obtained for the member, the provider of care, and the NALC Plan. Together they meet the needs of patients in comprehensive, quality care.

How do you know we only settle for the best?

	There are many industry standard gauges built into our medical and mental practitioners networks as well as into our nationwide pharmacy network to ensure high standards for quality of service. Besides a rigid credentialing process of organizations such as JCAHO and URAC in which our business partners are accredited, quality of care is also monitored through client and patient complaints and media reports. Provider education may be warranted to improve performance levels. The use of physician profiling identifies significant variations in physician-practice behavior that may warrant intervention. UBH provides educational material to providers containing appropriate use of various treatment settings and updates to show "best practices" guidelines planning.

You can expect quality and safety measures built into NALC Plan programs.

To maintain the best quality in service, our business partners conduct periodic audits and surveys to provide excellent treatment outcomes. UBH has licensed clinicians to conduct ongoing site audits and treatment record reviews. Corrective actions plans are required of all participating providers who do not score high in the overall audit process. First Health has a dedicated staff of professionals to network credentialing and quality assessment activities, including monitoring of provider disciplinary action, patient satisfaction surveys, and licensure and accreditation indicators. Caremark randomly sends a pharmacy audit letter/form directly to the patient to ensure satisfaction with their drug purchase. Onsite audits to a retail pharmacy may be required to examine specific prescriptions where aberrations have been noted and verify issues in a non-disruptive fashion.

Want to Know More?

To connect with our members through the internet, the NALC Health Benefit Plan offers valuable information on our "Health Center" through our web site at www.nalc.org/depart/hbp. Here members can link to safety, medical and educational information as well as to our business partner’s web site to view:

• United Behavioral Health's "Live and Work Well" site offers useful information on emotional well-being.
• Caremark's "HealthTalk" gives access to the latest information about chronic diseases and condition with online audio and video interviews with leading physicians and patients with the disease or condition. Caremark's Health Information Center offers information on a variety of medical conditions, including a Frequently Asked Questions section.

• First Health's web site gives not only a means to locate a PPO provider but to review current health topics and a tool that enables consumers to compare and select the best hospital for their individual needs.

Our members can connect daily with our 24-hour nurse help lines to access in-person support for a wide range of mental health and substance abuse concerns, including depression, eating disorders, coping with grief and loss, to name a few. Other toll free services allow NALC Plan members to discuss health concerns and treatment options with qualified medical nursing specialists in the privacy of their home and at a time of their own choosing.

These activities available through the internet, telephone and in writing can have an impressive impact on consumer's health and safety. To learn more about the NALC Plan and our special features, contact our office at 1-888-636-6252. Call us today and discover why NALC Plan members continue to rate the NALC Health Benefit Plan #1.