Federal Employee Health Benefits

Sioux Valley Health Plan Patient Safety Initiatives

Sioux Valley Health Plan and its participating providers acknowledge their responsibility to provide high quality safe care in a cost-effective manner through an ongoing monitoring, evaluation and improvement process. The key to our success is our network of primary care physicians, specialists and hospitals. In partnership with their health care providers, Sioux Valley Health Plan actively promotes health care education, prevention and early detection. Together we understand the need to deliver the best possible safe patient care, and maintain good community health while developing cost-effective solutions.

Sioux Valley Health Plan believes that in order to meet the needs of our patients and health care partners, everything we do must be of the highest quality, which includes patient safety, and value available in our region. By improving the quality of care provided, employing the best managed care practices and principles, and partnering with our consumers, employer groups and physicians, the Health Plan is able to assist in saving lives, reducing disability, improving productivity and managing health care costs.

Patient safety is a priority and Sioux Valley Health Plan does not separate quality from safety as demonstrated by our Quality Initiatives and educational programs. Our Quality Initiatives are founded on evidence-based clinical practice guidelines, which are available to all SVHP providers on our website. Education is pivotal to the success of our Quality Initiatives and will be provided to members by way of individual mailings, newsletters, worksite wellness programs and/or phone calls from health plan staff. Current patient safety activities are education based initiatives and are not outcome oriented. The current programs include (but are not inclusive in description) are:

New Baby Cards and Immunization Schedules-All parents of newborns receive a congratulatory cards and immunization schedule that contains the recommended immunizations from birth to age 16. Sioux Valley Health Plan covers all immunizations recognized by the CDC in the benefit package at 100%.

Adolescent Health Quality Improvement Activity-Our focus is on adolescents between the 6th and 8th grades. The program includes education regarding health risks and the need for annual visits to a primary care physician in order to establish a trusting relationship to foster open disclosure of future health information.

Summer Safety Guides-Is part of a community based project sponsored by Sioux Valley Children's and Lewis Drug and is designed to provide education on dealing with accidents, injuries and other summer safety issues. Summer safety topics are also published annually in the Sioux Valley Health Plan Member Messenger newsletter.

Preventive Health Guidelines-Are age specific and describe prevention or early detection interventions and recommended frequency and conditions under which intervention is required.

Breast Cancer Screening-All female members who are turning 40 receive a birthday card encouraging mammography and monthly self breast exams.

Women's Birthday Cards-All female members who are turning 18 and those turning 40 receive birthday cards reminding them of the importance of annual Pap Tests.

Smoking Quality Improvement Activity-This activity has included surveys, education and partnering with promotion of State Initiatives for advising people to quit smoking.

Disease Management Programs for Hypertension, Diabetes Care, Congestive Heart Failure, Asthma, Migraine and Medication Appropriateness for Depression-These initiatives include direct member mailings of educational materials as well as phone calls from health plan staff. The goal of each quality improvement activity focuses on the health, wellness and safety of our members.

Newsletters-Sioux Valley Health Plan disseminates educational information that promotes safe health practices to each of its members, providers of practice and contracted pharmacies on a monthly or bimonthly basis. In addition, on an annual basis patient safety topics and related website references are made available to our providers through the provider newsletter.

Medical Line-Sioux Valley Health Plan's Medical Director promotes safe health practices by educating the public by radio talk show each week for the tri-state area.

Case Management Worksite Wellness Program-The worksite wellness program focuses on population as well as individual case management principles. Worksite wellness programs encompass employee education regarding safe health practices as well as monitoring and educating on current disease states that are affecting the group population as well as the individual member themselves. The case managers' role will include group health screenings and annual educational sessions for the employees on the topic of "Clinical Safety" which includes going in prepared to the doctor's office, communicating with the doctor, communication tips, obtaining more information on your medical condition, etc.

Pharmacy Interventions-Sioux Valley Health Plan contracts with ESI, Inc. as our pharmacy benefit manager. ESI's computer system has a warning message that is sent back to the pharmacy entering the claim concerning potential drug interactions for our members. This system alerts pharmacists to potentially harmful drug interactions for our members.

Patient Safety- Sioux Valley Health Plan currently does not participate with the Leapfrog Group. Our network is our credentialed providers of service and Sioux Valley Hospitals & Health System (SVH&HS). Currently, SVH&HS has implemented a Patient Safety Initiative that includes the elimination of unacceptable and dangerous abbreviations. The initiative is being implemented in SVH&HS facilities including clinics, hospitals, long term care facilities, home health agencies and the Health Plan. Sioux Valley Hospital, SVH&HS's tertiary care facility, has a safety department with a designated patient safety officer, Tom Murray, as well as an interdisciplinary Patient Safety Council that provides oversight and consultation regarding the hospital's patient safety goals and initiatives. These goals and initiatives are achieved through staff education, safety competencies, reliable systems for collecting, trending, analyzing and reporting patient safety data, promotion of non-punitive confidential reporting of medical errors and rewarding "good catches" through a Service Excellence program, review of knowledge based information to identify potential risks, development of action plans based on errors/risks, and partnering with patients and families through education. Sioux Valley Health Plan will participate as necessary by gathering any needed information and providing an educational avenue to members through newsletters and special mailings.

Sioux Valley Health Plan will continue to educate their members on patient safety. The Plan is currently accredited by the National Committee for Quality Assurance (NCQA) under an Excellent MCO Accreditation, effective July 23, 2004. This accreditation denotes our commitment to quality of care and patient safety. By participating in the NCQA process this ensures that patient safety standards are required to obtain accreditation by any organization. Sioux Valley Health Plan will continue to promote strong quality initiatives that promote health and wellness of our members.