Federal Employee Health Benefits

New West Health Plan Patient Patient Safety Initiatives

Pharmacy Programs

New West Health Plan uses AdvancePCS as its Pharmacy Benefit Manager (PBM). Our contracts with AdvancePCS extend maximum savings to enable us to offset rising costs to our members. Our pharmacy riders consist of three-tier plans that extend the greatest flexibility for members to obtain the most appropriate medication while encouraging the use of the least costly alternative. This is accomplished by imposing higher co-payments for non-formulary brand and brands with generic equivalents. A mail order component is also included that encourages members to use mail order for chronic and maintenance medications. Mail order prescriptions produce higher cost savings for the plan and benefit our members. Members who use mail order receive three months of medication for two co-payments.

Provider Network

Our provider networks are continually being expanded. A larger provider network gives members more choice and helps maintain medical costs. We are encouraged to learn of the possibility of using a central clearinghouse for credentialing and hope that this will eventually ease the time and costs associated with provider credentialing. Additionally, New West holds contracts with the American Chiropractic Network and Mental Health Network for management of chiropractic and mental health services.

Preventive Care

New West Health Plan includes a multitude of procedures in its preventive benefit. We continually evaluate new and recommended procedures for consideration and subsequent addition to this first dollar benefit.

Care Management

New West Health Services is continuing to make a comprehensive evaluation of effective treatment and management of diabetes and migraine's. As well as continually evaluating pharmacy costs. New West is also continuing to compile data on childhood immunizations, breast cancer screenings, cervical cancer screenings, and CAHPS for adults. We are currently using predictive modeling and Summit Healthcare for interventions.

In 2004 our medical steering committee will continue to look specifically at asthma and hypertension. We will also continue to use predictive modeling and monitor our results to compare with national standards.

Preventive Care

Osteoporosis screening, adult immunizations, colorectal cancer screenings, cholesterol screenings, autologous tandem transplants are all covered benefits, providing that they are standard of care, and not experimental or investigational.

Consumer Education

New West sponsors a variety of activities to promote healthier lifestyles. These activities include quarterly Wellspring Newsletters to all members. The newsletters contain various articles on ways to stay healthy. We conduct health fairs where we provide health related information and we issue periodic mailings to our members of special literature aimed at increasing knowledge and understanding of health related issues. New West provides a 24 hour health-line that is available via phone or internet. The Internet has links to over 20,000 health related articles.

In 2004 New West will continue to stay active in looking for ways to reach our members with valuable information! As well as identify information that is important for the population we serve.

Fraud and Abuse

Fraud and abuse are addressed at several levels. First our claims system incorporates a type of "Code Review" where claims are evaluated systematically to determine if billing methodologies are appropriate. Edits include number of units, bundling, dupe edits, age and sex edits, etc. Efforts are also made at the time of claim entry as well as backend claim utilization review.

Patient Safety

Currently New West and its sponsoring hospitals are evaluating the Leapfrog Group's patient safety standards. The medical steering committee and the board of directors will continue to evaluate as we move forward and look at the prospects of improving patient safety.

Quality Initiatives

New West is currently not accredited. We are working toward this goal and hope to have full accreditation within the next 2-3 years.

New West conducts a CHAPS survey yearly to evaluate the satisfaction of our members. This information is used to assist New West in evaluating systems and processes used to service our members.

E-Initiatives

New West hosts a customized web page for Federal Employees. This page increases potential members understanding of the plan design, provides orientations to new members, and links to ancillary services. Our site will be expanded this fall with options to allow members to change addresses, PCP's, check claims status, authorization, etc.

FSA's

New West will work with the Federal program to increase understanding and value of FSA's. We will include any requested information in our 2004 brochure.

HIPAA

New West adheres to and is compliant with the requirements of HIPAA.

Emergency Preparedness

New West includes information on emergency preparedness in its Federal web link and will work with the Federal plan to increase awareness of this important topic.