Federal Employee Health Benefits

Fallon Community Health Plan Patient Safety Patient

Leapfrog Initiatives FCHP remains committed to the quality improvement principles embodied in the three Leapfrog Group initiatives - Computer Physician Order Entry, Evidence-based Hospital Referral, and ICU Physician Staffing.

FCHP continues to work in collaboration with the Mass Leapfrog Coalition to enhance patient safety for members treated at our contracted hospitals. With this collaboration, FCHP remains dedicated to educate our member and providers, encourage implementation of the Leapfrog Interventions and achieve incremental compliance for all our contracted hospitals.

FCHP continues to work with the Massachusetts Hospital Association to effectively prioritize and implement the Leapfrog project. FCHP is also continuing to provide our members and providers the proper tools needed for an effective and educated dialogue regarding our contracted hospitals and the progress for compliance to the Leapfrog Initiative. In adherence, FCHP continues to publish articles in the member magazine and provider newsletters, which address information specific to Leapfrog compliance. FCHP also provides a direct link on our website to the Leapfrog group so members can educate themselves on the initiatives as well as attain the names of the hospitals in the FCHP service area that is in or on its way to Leapfrog compliance.

In addition to the implementation plan for the Leapfrog initiatives, we also report the following progress with our outpatient safety programs:

Patient Safety
FCHP is in the process of developing a plan for collecting and providing information on provider and practitioner safety and quality. We will be developing activities to collect information on providers' actions to improve patient safety and make performance data publicly available for members and practitioners.

Web-based Health Education Program
As one of FCHP's missions to make our communities healthy we have implemented an initiative to promote the well being of plan members in order for them to understand and manage their important health issues. FCHP is currently working with a pharmaceutical vendor to implement a web-based education program of disease management modules, as well as modules in wellness, women's health, and health screening.

Public Report Card on Quality
FCHP supports our mission through our values, which are genuinely held beliefs that guide all of our communications and actions. Our values demand that we communicate, clearly and honestly to our members as well as strive to achieve the best possible results. In pursuing our values, FCHP is in the process of developing a report card on quality for contracted physicians. These report cards will be based on statewide rates and offer consumers information to assist them with making choices about their health care. This initiative will identify a top performing network of providers and communicate to enrollees those physicians in the network with higher statewide rates for quality in a consumer-friendly message.

Advancing Better Care (ABC) Project
FCHP's mission, guiding values and vision for the future direct the way we communicate with members and the benefits we offer. FCHP understands that being healthy improves quality of life therefore we are participating in a collaborative project with Alliance of Community Health Plans (ACHP) to focus on engaging and activating patients to become more involved in their care. This project proposes to develop a member education and awareness campaign for the quality measures that Massachusetts Health Quality Partners will be publicly releasing in 2004 using the health plan's HEDIS aggregated results

Drug Utilization Review

The FCHP Drug Utilization Review program uses prospective, concurrent and retrospective mechanisms to provide a complete spectrum of review.

• Prospective review consists of a pharmacist verifying that medications are used appropriately for dosage, side effects, monitoring parameters and disease state.

• Concurrent and retrospective review utilizes parameters such as effectiveness, age of patient, drug interactions, drug disease interaction, compliance rates, lab values and costs.

The review program details the prescribing patterns of individual physicians and patterns by specialists. This information generates a report that indicates the actual number of prescriptions written compared to a targeted number. The report also specifies the average cost of prescriptions for brand and generic prescriptions. These reports are then used in conjunction with either nationally developed guidelines or FCHP developed guidelines, for informational material for physicians to assist them in determining the most appropriate and cost effective medications to prescribe. Prescription reports are sent to the physicians on a monthly basis. This includes data on monthly volume, cost, department averages, site averages, specialty averages and total costs. Physicians are also sent information in specific drug reports, specific drug class reports and specific drug-drug reports.

As part of our drug utilization review program our PBM, PharmaCare Service Inc., provides a complete online member profile to pharmacies so the pharmacist can monitor the different types of medications for possible adverse reactions.