Federal Employee Health Benefits

APWU Health Plan Patient Safety Initiatives

At the APWU Health Plan, we are aware that you, as Federal consumers, are at the center of health care decisions. Therefore, we want you to know that we are continually striving to put programs in place that will enhance your safety as a healthcare consumer.

The Health Plan has a patient safety officer who works in the Care Management Department of the Health Plan. In this capacity, the patient safety officer works closely with our Preferred Provider Networks (PPO) and Pharmacy Benefit Manager, Medco Health, in order to monitor existing and new programs designed to promote patient safety. The patient safety officer also works with the Health Plan's Member Education Department on articles for our member newsletters and on information for our website, designed specifically to increase your knowledge about how to keep yourself and your family safe while navigating the healthcare system.

The APWU Health Plan has two benefit options for you to choose from: the High Option and the Consumer Driven Option. So, we would like to tell you about the patient safety initiatives we have in place for both of these options.

We want FEHB Program High Option Consumers to know that:

• The APWU Health Plan provides you with information on safety, prevention and making sound health choices in both print and on the APWU Health Plan's website. Examples of this type of information are:
  • Articles in The HealthConnection, the quarterly membership newsletter, on topics such as tips on talking to doctors and preventing medical errors, and an entire issue dedicated to healthy lifestyles.
  • A series of articles promoting healthy lifestyles through prevention have been included in APWU and affiliate publications.
  • APWU Health Plan's website includes a section on Tips on Healthcare and Patient Safety with links to other helpful sites. This section includes information on preventing medical errors and preventing errors with prescription medications. It also contains a link to the Agency for Healthcare Research and Quality (AHRQ) that includes information on preventing medical errors.
  • New to the website this year, from the PPO Directory lookup, is a link to HealthGrades, a company that rates hospital quality based on three years of MedPar (Medicare Provider Analysis Review) data. Members can compare hospitals based on specific procedures, survival rates, complication rates, and recovery rates. Hospital data is also available regarding responses to the Leapfrog Group Survey on patient safety. All of this new information helps our members make informed medical consumer decisions.
  • A link to ValueOptions' Achieve Solutions website on mental health and medical care was recently added to the APWU Health Plan's website to provide you with member support and information.
  • The APWU Health Plan's website includes a link to the Mayo Clinic health library.
• You have access to a 24/7 Nurse Advisory Line, which answers your questions about treatment options, such as whether or not it would be appropriate to seek treatment in an emergency room or what a procedure entails. At your request, The Nurse Advisory Line, will send you brochures on various medical topics. They also send out quarterly newsletters and postcards discussing various topics of interest.
• You have access to 9 different Medical PPO Networks. All of the Networks credential their providers and hospitals based on standardized criteria, which also serves as a safety mechanism for you. Several of those Networks, as well as our Utilization Review/Case Management and Behavioral Health vendors, are either NCQA or URAC Accredited. A few of the Networks have hospitals that are participating in the Leapfrog Initiative, which is a national study on patient safety.
• The APWU Health Plan and Medco Health, our Pharmacy Benefit Manager (PBM), has several programs in place that promote patient safety. One of those programs is RationalMed. The goal of the program is to reduce illnesses and hospitalizations due to incorrect dosages, incompatible combinations of medications, misuse of medications or unneeded treatments. Medco also has concurrent and retrospective programs that monitor drug usage, thereby helping to prevent prescription drug errors. When necessary to prevent a possible safety issue, Medco will share drug profiles with the patient's doctors.
• In 2004, the Health Plan partnered with a Disease Management Program, CorSolutions that addresses chronic disease states such as Diabetes, Coronary Artery Disease and Chronic Obstructive Pulmonary Disease. The objective of this program is to educate and empower our members, and assist the member in navigating through the healthcare system. A potential participant should expect to receive a letter of introduction, an initial contact phone call and ongoing contact with a clinician. Based on your agreement to participate, the Care Counselor may contact your doctors in order to share pertinent medical and prescription drug profile information. They may also issue evidence-based guidelines to your doctors in order to assist with treatment recommendations.
• In 2004, the Health Plan partnered with NCQA-certified MedSolutons to provide decision support for high tech diagnostic imaging, such as PET Scans, CT Scans and MRI's. The goal of this radiology management program is to ensure that patients receive the best possible imaging exam for their condition, preventing unnecessary exposure.

APWU Health Plan's Goal
The Health Plan's goal is to provide you with the information you need to be good consumers. We want to encourage you to be proactive, as you access needed healthcare. The goal of the information we make available, whether on the website, in print media or via the Nurse Advisory line, is to provide you with the information you need to make good decisions. We want you to realize that you need to take responsibility for yourself. You need to be knowledgeable; to ask questions; to write things down; to share pertinent medical information with your provider, and to have a family member or friend act as your patient advocate if you are unable to do it on your own. The overall goal is to encourage you to be proactive and informed about your healthcare. The expected outcome is much the same; that you will feel more in charge of your healthcare because you are more knowledgeable.

Evaluating Results
The Health Plan has input into questions that are asked by our Nurse Advisory Line when they conduct their annual member satisfaction survey. Some of the questions ask whether the information you received in reference to your care helped you make an appropriate, safe, healthcare decision. In 2004, the Health Plan will also receive data from Medco Health. The data will enable the Plan to evaluate how our pharmacy programs helped to avoid drug errors/interactions and how the programs potentially decreased the need for care, which would otherwise have been necessary without intervention of the Medco programs.

We want FEHB Program Consumer-driven Option Consumers to know that:

Definity Health administers the APWU Health Plan's Consumer-driven Option. When you enroll in the Consumer-driven Option, you will have access to the Personal Care Support program, which is managed by Definity Health's Medical Director.

• The Personal Care Support program promotes patient safety and the reduction of medical errors by:
  • Analyzing pharmacy and medical claims on a monthly basis in order to identify if you have a chronic condition, such as Diabetes, Coronary Artery Disease or High Blood Pressure. If the analysis shows that a diabetic patient hasn't had an evidence-based, recommended blood test (HgbA1C) in three months, the Care Support team will make a phone call, send mailings and/or e-mail a notice to the member recommending that they have this test done, and give them the reasoning for the test. They do this in order to engage you, the patient, in getting involved and educated about your disease process. Also, at appropriate ages, Definity Health will send out information recommending that you have certain preventive tests done. If you call Definity to notify them that you are going to have a surgical procedure, their health coaches can help you determine if there is a less invasive and possibly safer treatment option available.
  • Publishing hospital quality information (where available), including information about services associated with better patient outcomes such as Computerized Physician Order Entry systems, full time critical care physician staffing, and surgical procedure volume for common major procedures.
• A key component of the Definity Health Patient Safety program is their Health Coaching service. Health Coaches are available 24-hours a day to provide you with decision support and disease management services to ensure that you receive the appropriate care. The Coaches provide support for a vast array of conditions, including in-depth programs for members with chronic diseases such as Diabetes, Asthma, Chronic Obstructive Lung Disease and Coronary Artery Disease.
• Definity Health's decision support services are designed to encourage you to collaborate with your physicians in order to make the best treatment-selection decisions possible. Their support services can educate and coach you on such topics as medical error prevention; risk factor reduction; medication compliance, contraindications and interactions; and informed medical decision-making. For example, if you call and tell Definity that you are having a certain surgical procedure, they can help you determine if a less invasive, possibly safer treatment option is available. On average, these services have been shown to reduce the rate of unnecessary surgery by 30%. Unnecessary surgery is a significant factor driving poor quality care and medical errors, so this is a very helpful tool.

Members who may especially benefit from these decision support services include, but are not limited to, the following conditions:

• Breast cancer: lumpectomy and radiation vs. mastectomy
• Low back surgery
• Arthritis and lower extremity joint replacement
• Prostate cancer surgery
• Coronary artery disease treatment and bypass graft surgery
• of life treatment
• Hysterectomy for benign uterine conditions

Definity and Medco Health, our Pharmacy Benefit Manager (PBM), has several programs in place that promote patient safety. The goals of the programs are to reduce illnesses and hospitalizations due to incorrect dosages, incompatible combinations of medications, misuse of medications or unneeded treatments. Medco Health also has concurrent and retrospective programs that monitor drug usage, thereby helping to prevent prescription drug errors. When necessary to prevent a possible safety issue, Medco will share drug profiles with the patient's doctors.

Definity Health strongly believes that member-focused programs are the most effective way to promote medical error reduction. Using web based tools and customer service, you have the opportunity to review physician and hospital quality through the TopDocs icon and the hospital facility tool on our web site, www.definityhealth.com (User ID: APWUHP, Password: HPINFO). TopDocs highlight providers who have been selected by their peers, and the hospital facility selection tool prioritizes institutions based on various quality components, i.e. complication/morbidity rates, number of procedures performed, etc. These tools provide you with an additional opportunity to become more knowledgeable and make wise healthcare decisions.

Definity Health's Goal
Definity Health's goal in providing patient safety support for you is to reduce the rate of medical errors while continuing to improve member satisfaction. Definity believes that the most effective way to achieve this goal is to educate you by providing you with clinically proven outcomes so that you can work together with your physicians to ensure that you are making sound medical decisions.

Evaluating Results
Definity Health consistently monitors their programs in order to ensure on-going success and future effectiveness. This is performed by tracking member usage of the website with regards to the use of patient safety web tools and information sources. Definity Health conducts and reviews member satisfaction surveys focusing on their Health Coaching and Personal Care Support services, including the Patient Safety program. Definity Health also analyzes claims data to determine if the program decreased the need for care, which would otherwise have been necessary without their intervention.