Federal Employee Health Benefit

ADVANTAGE Health Solutions, Inc.

A goal of ADVANTAGE Health Solutions, Inc. ^sm is to continually strive to improve the outcomes of the health, quality of care and services delivered to our members. In 2000, ADVANTAGE implemented its strategic patient safety program. A patient safety officer was put in place and key initiatives began. This included sharing information and working with key stakeholders to help them better understand the importance and strategy behind improving patient safety and reducing medical errors. In addition, ADVANTAGE began to assess the readiness of our network hospitals in regards to Leapfrog and other patient safety initiatives. In 2003, ADVANTAGE received an "Excellent" three-year accreditation status by The National Committee of Quality Assurance (NCQA). During that survey, it was clear that patient safety has become a key initiative for the health plan and in 2003 there were no complaints, appeals or quality of care issues regarding patient safety.

To date, the roll out of our patient safety program includes:

• Appointing the Vice President of Medical Affairs as the safety officer.
• Incorporating patient safety monitors into ADVANTAGE's quality improvement plan.
• Involving the Patient Safety Educator in ADVANTAGE's annual Provider education program.
• Incorporating patient safety education in all member welcome packets and formulary documents.
• Linking ADVANTAGE's web site to Leapfrog's web site for providers and employers.
• Adding a patient safety node for members, providers and employers to ADVANTAGE's web site.
• Being involved in Michigan Health and Safety coalition.
• Mailing educational materials to providers of care.
• Completing an appropriate use of antibiotic campaign.
• Tracking patient safety issues through appeals, complaints and quality of care reports.

Activities of which Consumers should be aware:

• Health Plan's assessment of network providers (i.e. hospital) safety initiatives and sharing with other hospital delivery systems.
• Assessing rates and reasons for ADVANTAGE members' readmission.
• Enhancements of the health plan's drug interaction program.
• Ongoing patient safety education in all member and provider newsletters.
• Developing and communicating targeted education materials such as:
  Appropriate Medication usage;Safety related to generic medication;
  Risk for drug poisoning;
  Summer safety tips;
  Talking to your physician;
  Appropriate antibiotic usage;
  Preventing errors in your care;

Goals of expected outcomes:

• Decrease the number of hospital admissions and emergency room visits related to drug interaction or overdose.
• Decrease avoidable readmission rates.
• Increase the participation of network hospitals in Leapfrog.
• Decrease complaints, appeals and quality of care issues.

Tools used to track progress:

• Pharmacy data
• Claims data
• Member appeals, complains and quality of care reports
• Leapfrog's reporting on hospital participation

ADVANTAGE's commitment to patient safety continues to be incorporated into our Quality Improvement Program just as it has since its inception. These initiatives involve continuing our evaluation of network providers, monitoring the potential risk for drug interactions and educating our members and providers. In addition, since medication related errors are the number one problem affecting patient safety, we have continued to enhance our pharmacy reporting capabilities. Drug interaction and polypharmacy reports have become a major component of our medical management oversight process. The outcome of this is direct reporting to providers of potential or adverse drug related issues that have or could have adversely impacted the members. Through our Pharmacy Benefit Manager (PBM), we have implemented PharmaReview. This is a "real-time" system that allows ADVANTAGE direct access to members' pharmacy data in addition to reporting capabilities.

Based on the data gathered and our continued efforts, ADVANTAGE Health Solutions will monitor and work with our network providers to create collaborative initiatives to make sure that our members receive quality medical care and services in a safe environment. In addition, we will continue to monitor our internal processes as we look for ways to enhance our methods to assure members' safety.