Anthem Blue Cross and Blue Shield, Midwest Region

Patient Safety Initiative

Anthem is committed to delivering products that promote quality; cost-effective medical care and services by qualified professionals who serve the needs of our members through managed care. Quality is the degree to which accepted clinical and member satisfaction standards are met or surpassed. Patient safety is an integral part of our Quality Improvement Program.

Case Management

Anthem considers member safety to be an important quality initiative. Anthem's policy is to help manage potential safety risks as appropriate to protect Anthem members receiving case management services. When potential risks to member general welfare and/or safety are identified, actions are taken to address the risks. Examples include:

• Consumer Safety

  Case managers have information available on the Anthem Midwest Case Management Intranet Website regarding available consumer safety and consumer protection resources, which includes links to the following resources:

  • Elder Rights and Resources
  • Disability Assistance and Assistive Technology
  • American with Disabilities Act (ADA)
  • Disability Rights and Laws
  • Legal Assistance (including Legal Aid Societies in all 50 states)
  • Laws and Regulations Regarding Consumer Protection

• Assessment of Threats to Member Safety
• Reporting Suspected Abuse and/or neglect
• Handling Suspected Emergencies During Telephonic Contact

Pharmacy

Anthem Prescription Management (APM), the wholly owned Pharmacy Benefit Management (PBM) of Anthem Insurance Companies, Incorporated, has initiatives targeted at promoting prescription drug safety. APM approaches prescription drug safety from several different platforms that look at a "distribution channel" for a typical medication before, during, and after the time when a prescription is written.

Formulary Management

The formulary represents rigorous clinical review, evaluation and decision-making related to the safety and efficacy of the approved drugs. The Anthem Pharmacy and Therapeutics (P&TC) Committee and Anthem Prescription Clinical Department have an excellent track record of independent, thorough review of prescription drugs.

• Protecting our members: The P&TC proactively monitors medications that have shown potential to cause adverse events in patients. In the past, the P&TC have removed several medications from the formulary based on adverse event profiles. These formulary changes occurred before the FDA recommended removal of these medications from the market.

Member, Pharmacy, and Physician Education

Prescription drug therapies can play a significant role in improving or maintaining members' health. However, prescription medications also carry the potential for misuse.

• Member Education: Anthem Prescription distributes member-targeted prescription drug information and safety guidelines in a variety of ways, including:

  • Personalized Member Letters
  • Internet Resources
  • Drug Recalls/Withdrawals
  • Patient Advisory Leaflets (PALS)
  • Pharmacist Counseling

• Pharmacy/Pharmacist Education: Network Pharmacies receive an extensive training manual and are subject to periodic on-site audits by Anthem Prescription. A biannual newsletter, Network News, is distributed to network pharmacies with information vital to drug safety, including drug recall or manufacturer shortage notifications.

  Internally, the New Drug Pipeline Report is distributed whenever the FDA approves a new medication to market. This report includes important information such as adverse events, dosing, and availability. In addition, the Institute of Safe Medical Practices newsletter, distributed monthly, contains information about common drug errors.

• Physician Education: Physician education occurs in person through the Clinical Account Pharmacist visits and via informational faxes, medication alert bulletins, Clinical Frontline educational materials, and our quarterly clinical newsletter, Rx Perspectives, all of which APM distributes regularly to the Anthem network physicians.

• Medication Safety Brochure: This brochure is distributed to physician offices and provides information for patients on the importance of medication safety. It includes questions that patients should ask their health care provider to help them take their medications properly.

Anthem's Mail Order Pharmacy (Anthem Rx Direct)

When a prescription is sent to the mail order pharmacy (Anthem Rx Direct), members are encouraged to complete an order form that includes the patient's medical history, known drug allergies, and other medications he/she currently takes. This information helps to ensure that the most current patient history is available and helps avoid possible adverse events.

Anthem Rx Direct consistently maintains an accuracy rate of 99.99%. In a mail service environment, extra steps are taken to help ensure order accuracy. For instance, at least two pharmacists and a pharmacy technician examine each prescription before it goes out the door.

Calls are made to the physician for prescriptions that need clarification or problem resolution as APM pharmacists identify issues associated with a submitted written prescription.

Clinical Connection

Clinical Connection is the point of sale screening process that occurs each time a member presents a prescription to be filled. It includes both prescriptions presented at retail pharmacies and prescriptions filled by the Anthem Rx Direct Mail Service Pharmacy. Connection edits incorporate a series of guidelines in the claims processing system that identify potential medication issues. When a potential intervention is identified, a predetermined edit message is sent to the pharmacy's computer screen. The edit alerts the pharmacist to the potential problem and may recommend ways to resolve the situation.

Creating Awareness for Medication Safety (CAMS)

CAMS is an additional program that was launched by APM in 2003 to focus specifically on initiatives designed to promote medication safety awareness among members, physicians and pharmacists. Initiatives include:

• A Pilot Project identifying members who are noncompliant with their medications and providing them with medication safety information and tools including the APM wallet card and Pill Box to promote awareness.
• Addition of Connection Edits for High Risk Error Medications.
• Translation of several current communications into Spanish.

Disease Management

Anthem Midwest's disease management programs include population-based programs for members with congestive heart failure, coronary artery disease, diabetes, asthma, chronic obstructive pulmonary disease and chronic kidney disease. We also have programs for women who are pregnant and we have general prevention programs. All of the programs are multifaceted with many member and provider interventions. Goals are developed and measurements are conducted annually which include clinical, cost and satisfaction outcomes. All programs are based on national guidelines and we have condition specific physician input in the form of an advisory panel for each of the programs.

Hospital Quality Program

Anthem Midwest has the Hospital Quality Program. The Program's purpose is to identify and measure the quality of medical care that network hospitals deliver to Anthem Blue Cross and Blue Shield's members. Patient safety was added to the Program in 2000 and this section continues to expand based on current medical literature, national quality organizations and accrediting bodies' requirements. The hospitals supply data to Anthem annually on clinical outcomes, process measures and their quality improvement program. The information is analyzed and blinded comparison feedback graphs are sent to the hospitals for their review.

Additionally, an annual meeting is held in each of the three states (Ohio, Kentucky and Indiana). Hospital quality improvement personnel are invited to attend and share "best practices" amongst the network hospitals. Patient safety is a focused topic at these meetings.

Member Education

Anthem Inc. has a leadership group that provides oversight of the patient safety information on MyHealth@Anthem.com. The web site has multiple links to other web sites that provide valuable information regarding patient safety. The group meets monthly to review and update the information available to our members.

Clinical Quality Issues

Anthem Midwest researches complaints made by members related to clinical quality issues to determine appropriate interventions. All incidental potential clinical quality issues/ member complaints against providers (e.g., physician, hospital, and ancillary) are coordinated through the Quality Improvement Department for investigation and follow-up. Potential clinical quality issues are those identified by Anthem associates in departments other than the Quality Improvement Department, e.g., Member Services on behalf of the member, Network Management, On-Site Concurrent Review, and Pre certification whereas member complaints are received directly from the member. All potential clinical quality issues are investigated, resolved, and trended for recurrence. The issues are reviewed; action plans are developed and implemented which include interaction with the physician and other providers as appropriate.