Federal Employees Health Benefits Program

Mercy Health Plans Patient Safety Initiatives

Mercy Health Plans is consistently building on its variety of resources that allow you to be the center of health care decisions. These efforts are aimed at improving:

1. compliance with our best practices,
2. the quality of your health care experience,
3. outcomes of health care treatment plans, and
4. your safety.

At Mercy Health Plans, we embrace a culture of patient safety through education and outreach efforts, reporting/intervention strategies, web-based tools, and telephonic support system. Our goal is to provide you with the information needed to effectively participate in both the decision-making and treatment processes. In addition, we strive to assure that our providers are well-informed on our best practices and their outcomes, so that they can facilitate the most effective treatment plan for you.

Mercy Health Plans is led by a team of individuals who emphasize you, the member, as the focus of our business. Our Corporate Compliance Officer and Chief Medical Officer provide a multi-disciplined leadership in patient safety, and together they function as our patient safety officer. These individuals lead committees that drive continuous quality improvement and patient safety initiatives, such as the Quality Improvement Committee and Corporate Compliance Committee. All Mercy Health Plans' teams are responsible for carrying out the committees' recommendations and work plans.

All quality improvement programs and interventions are focused on you, our member. We apply our best practices to improve outcomes, while always keeping your safety in mind.

Physician and Hospital Quality Recognition Program

Our web-based provider directory provides you with information on physicians and hospitals recognized for their commitment to quality and safety. This directory can be accessed at http://www.mercyhealthplans.com/doctor/default.asp. We recognize providers dedicated to quality with the following icons:

The Leapfrog Group for Patient Safety symbol is an indicator on our website that a hospital has complied with the reporting requirements of the Leapfrog Group for Patient Safety. We are proud to be affiliated with St. John's Mercy Medical Center in St. Louis, the first St. Louis-based provider to report their outcomes, as well as several other providers that report to the Leapfrog Group.

The Malcolm Baldridge Award is an indicator on our web site that the hospital or physician is affiliated with SSM Health Care, the first health care provider ever to win the Malcolm Baldridge Award for quality. This provider has been able to meet the rigorous standards of the Malcolm Baldridge organization, including patient safety.

The Blue Ribbon Award is an indicator assigned by Mercy Health Plans to physician groups that agree to participate and report quality improvement results via the Internet. Mercy Medical Group is the first physician group to participate. Results (from both a clinical and service perspective) are available at www.mercyhealthplans.com/scorecard/page2.htm. Examples of results include:

Member, Provider, and Other Profiling Activity

Mercy Health Plans monitors outcomes at member, product, provider network, and provider group levels. This information is distributed to physicians via newsletters and the Mercy Health Plans' website.

Physicians receive exception reports on members who have not obtained age/gender-appropriate immunizations and other preventive services. Mercy Health Plans notifies participating physicians when a member with diabetes is assigned to a particular physician and has not received recommended testing or services.

In addition, we have begun profiling on the use of services, such as emergency room and radiology. These results are shared with provider networks and groups. We anticipate publishing information on our website in the future. Various other reports are generated to better identify members who may benefit from a Mercy Health Plans’ Disease and/or Care Management program.

Mercy Health Plans provides you with information from other sources to assist them in the decision-making process. This includes but is not limited to:

• 2002 Missouri Consumer’s Guide to Hospital Surgery Volume
• The Leapfrog Group website
• Health Care Procedure Pricing (Eastern / Central Missouri Region only at this time)

Other Patient Safety Initiatives

Radiology Safety

We provide physicians with access to HealthHelp’s RadConsult program to assist in making the best decisions regarding medical imaging. Physicians are required to seek specialty consultation prior to ordering spine, neck and head computerized tomography (CT) and magnetic resonance imaging (MRI) procedures. This process is intended to enhance both your care and the educational process for referring physicians.

The radiology consultants will provide referring physicians with "evidence-based" resources regarding the most appropriate use of CT and MRI procedures. By making the most appropriate imaging decision, physicians can improve and expedite your well being while limiting radiation risks.

Information on radiology safety is a routine part of member newsletters and Mercy Health Plan’s website.

Surgery, Patient Education, and Informed Decision-Making

Having surgery? Are you expecting a baby? Your health is important to us. That’s why we have partnered with Graphic Surgery. To provide a new online tool that can help you prevent problems by learning about your medical procedures prior to surgery or the birth of your child. When you log on to www.mercyhealthplans.com, you will be able to preview surgical procedures (graphically illustrated using 3-D animation) and learn about potential complications and outcomes to expect as a result of that procedure. Through this website, you can:

• View up to 40 common surgical procedures (using 3D animated graphics) from start to finish;
• Understand potential risks of each surgery;
• Learn possible complications that may arise after surgery;
• Know what to expect when recuperating from a procedure;
• Identify appropriate questions to ask your physician prior to the procedure.

Graphic surgery is just one more way Mercy Health Plans is working to give you the health information you want and need. Learn more about Graphic Surgery at www.graphicsurgery.com.

Our tools are meant to open up the health care process, reduce errors, and ensure that safe practices and environments are available for you. We have been bringing you the patient safety message directly via the Internet (articles, tools, and interactive activities), member newsletters, and supporting provider resources. Mercy Health Plans is consistently building on its variety of resources that allow you to be the center of health care decisions.