Federal Employee Health Benefit

KPS Health Plan Patient Safety Initiatives

http://www.kpshealthplans.com

High Option		Standard Option:
VT1 Self Only		L11 Self Only
VT2 Self and Family		L12 Self and Family

• Pharmacy Case Management
• Medical and Behavioral Health Care Management
• Member and Provider Education

Our efforts in these areas are intended to help you:

• Increase your understanding of diseases and treatment options
• Better understand your health care benefits
• Access resources and support groups

To know just how well these programs are working, we do regular reviews of:

• Medical and pharmacy utilization
• Member satisfaction surveys
• "Hits" to our web page and links to resources and support groups

To ensure our patient safety activities are appropriate and effective they are reviewed and approved by our Patient Safety Officer who is a board certified internal medicine doctor.

Prescription Drug Safety

Our pharmacy benefits management company, MedImpact, has an online Drug Utilization Review (DUR) program that assists physicians and pharmacists in ensuring safety in the prescribing and filling of prescriptions.

The program provides the following:

1. Information on potential drug interactions
2. "Sound Alike, Look Alike" warnings to make you aware there are drugs that look similar in form or have a similar name
3. Monitoring and notification of:
   1. age precautions
   2. gender specific drugs
   3. pregnancy precautions
   4. minimum and/or maximum daily dosing
   5. therapeutic duplication of drugs

Disease Management Programs – Education, Treatment and Follow-up

• KPS uses pharmacy case management for chronic diseases that require long-term or life-time self-injectible medications

  We are currently targeting these specific diseases:

  • Multiple Sclerosis
  • Hepatitis C
  • Rheumatoid Arthritis

  • Growth Hormone Deficiencies

  At no additional cost, this program allows you to benefit from:

  • Disease specific education
  • 24 hours - 7 days a week access to Customer Service vRepresentatives, Pharmacists and Registered Nurse Case Managers

  • Convenience of having prescriptions mailed directly to you

• KPS is implementing a new pharmacy program

  The program is called, Patient Choice. It will enable you to be involved in the prescription decision-making process, help you save money on your prescription drug copayments, and improve your understanding of the drug list.

• Medical and Behavioral Health Care Management

  Our Registered Nurses focus on your needs by ensuring that the highest quality of care is provided at the most appropriate level of care. You have access to Registered Nurses for all Behavioral Health issues.

• Member and Provider Education

  Our web site provides a variety of educational materials. Our wellness brochure outlines the programs we offer as well as printable brochures on specific guidelines such as health and fitness, prenatal care and mammograms. We provide links to a wide range of general health topics, as well as specific disorders commonly encountered that provide quality, scientific, evidence-based information. We feature a specific site each month that provides information on patient safety.

• Pharmacy Program Outlined

  All aspects of the pharmacy program are outlined on our web site.

  • Monthly updated drug list
  • Recommended alternatives for Tier 3 drugs
  • Pharmacy and Therapeutics Committee recommendations

  We provide links to ePocrates ― a software program that provides your drug list directly to your doctor.

Other Facts

• KPS utilizes evidence-based criteria in all decisions and make them available to our providers.
• KPS issues our providers information on their prescribing patterns compared to their same specialty peers. This program provide information and education that emphasizes drug efficacy and safety, promotes cost-effective prescribing and highlights best practices in pharmacy economics.
• We provide patient safety information in our bi-monthly provider newsletter, the KPS Report, as well as on our web site.
• KPS works closely with our largest provider of hospital services, Harrison Memorial Hospital to ensure quality of care. In 2003 Harrison Memorial hospital successfully launched an inpatient Hospitalists program. This program allows in-house physician care around the clock every day. Patients in the critical care units receive care from physicians who are either board certified or eligible in the appropriate critical care specialties.
• Additional patient safety efforts include:
  • An enhanced provider network consisting of credentialed, quality providers and facilities
  • A competitive pharmacy network audited annually to ensure quality and competency
  • Credentialing and Peer Review performed by Northwest Credentials Verification Service (NCVS), an affiliate of KPS Health Plans
  • A comprehensive provider and member appeals process
  • A comprehensive quality of care and quality of conduct investigation process