Federal Employee Health Benefits

Avera Health Plans Patient Safety Initiatives

Patient Safety Officer

Assuring the safety of patients/members as they access healthcare services or in the handling of PHI is a shared responsibility among the executive staff of AHP. The AHP Quality Council comprised of the President/CEO, Medical Director, and the Directors of Health Services and Operations are responsible for AHP's patient safety programs and initiatives. The Board of Directors of AHP has oversight of the patient safety activities of AHP.

Drug Utilization Reviews

Member safety is always key to our prescription drug operations. Through our pharmacy vendor, Express Scripts Incorporated (ESI), we receive the most recent drug alerts. AHP, through ESI's online claims editing process, provides online alerts to assist in ensuring the safety of prescription medications received by the plan members.

To assist AHP network providers with prescribing for AHP members and following best practice guidelines AHP has established Regional Care Councils of participating physicians for local evaluation of AHP's operations. One of the Regional Care Council's current initiatives is the investigation of electronic prescribing. E-Scribe is one of those software packages being evaluated.

Disease Management Programs

AHP members with chronic conditions/disease states are encouraged to participate in AHP's Care Coordination program. Care Coordination, a care management program designed to support members and providers, works to identify health care risks or existing health conditions. Care Coordination offers support and assistance in access to information, treatment protocols and community resources to directly support AHP members and their families.

Evidence-based Guidelines

AHP encourages the use of best practice guidelines published by ICSI (Institute of Clinical System Improvement) to assist doctors in making treatment recommendations. Evidence based guidelines are made available to providers through direct mailings and broadcast publications including newsletters and web links for physicians.

Individual Patient Prescription Drug Profiles or Patient Disease Profiles AHP provides support to physicians to assist them in achieving desired outcomes for AHP members. Among these supports are clinical guidelines, Care Coordination and the Regional Care Councils. Individual disease profiles or service utilization reports are not routinely distributed to the attending physician. Individual member information is shared by AHP, through Care Coordination efforts, as necessary to achieve desired outcomes.

Physician Newsletters

AHP provides each of its providers with a quarterly newsletter called the ProviderView. Progress reports on patient safety activities and strategic initiatives underway at AHP are shared with the provider community through this newsletter.

Recognition Program

Avera Health sponsors an Annual Quality Recognition Award program with awards presented to a number of individuals and groups for initiatives to promote quality in caregiving. AHP's Care Coordination program was nominated for and received the Caring With Excellence award for 2003.

Other Patient Safety Activities

The state of the art in healthcare calls for accurate and real-time performance measurement for purposes of effective planning and decision-making. AHP addresses this measurement need by way of MedInsight, a state of the art computer program, healthcare data warehouse and performance reporting system. MedInsight provides a way for AHP's Health Services department to discover the nature and source of health costs and to identify, track and manage patient health risk. Medical and pharmacy services are consolidated and categorized allowing detailed comparisons with local and national best practices. Utilization and cost benchmarking offers the ability to compare medical service utilization and cost against national and local benchmarks. In total, MedInsight allows retrospective analysis of data by AHP committees to meet the mission statement for the Quality Program for Health Services.