Federal Employee Health Benefit

FIRSTCARE Patient Safety Initiatives

FIRSTCARE concurs with OPM's philosophy that our members are at the center of health care decisions and are dedicated in our efforts to promote patient safety initiatives for all our members.

The FIRSTCARE Interregional Quality Improvement Council (IR-QIC) continues to address and monitor the delivery of quality health care and customer service throughout the FIRSTCARE service delivery areas (Enrollment Codes CK - West Texas, and 6U - Waco Area). Because of FIRSTCARE's unique relationship with its "partner hospitals", we are able to take a comprehensive approach to help ensure patient safety. These approaches include:

• Quality management/improvement programs,
• Credentialing and re-credentialing of our providers,
• Member satisfaction surveys,
• Provider satisfaction surveys;
• Clinical practice guidelines,
• Standardized utilization management procedures, and
• Analyzation of complaint and grievances systems.

Monitoring of patient safety issues occurs through the following:

• PCPs and specialists practice patterns are monitored and reported periodically to the Regional Medical Director Committees. FIRSTCARE clinical studies involve the monitoring of practitioner compliance against diabetes, asthma, immunizations and preventive health nationally recognized guidelines.
• Complaint data is tracked, trended and analyzed for quality of care issues at the regional and corporate level. Any dissatisfaction expressed by a member is investigated, and findings of each review are corroborated intra-departmentally at the regional level.
• Sentinel events such as unexpected death, medication or medical errors, hospital-acquired infections, etc., are reported and investigated by the regional QI departments. These QTAG (Quality Tag) events are tracked and trended and reported to the QI Committees, as well as to a peer review body, as warranted.
• Each contracted provider must submit all pertinent documents at initial credentialing and every three-years thereafter for re-credentialing. The primary source verification process includes verification of licensure, medical education, board certification, provider is in good standing with state medical boards, and National Practitioner Data Bank findings.

Regional QI departments conduct medical records reviews on high volume behavioral health specialists on an on-going basis. Biennially, random samples of five patient medical records are reviewed to evaluate practitioner compliance against FIRSTCARE medical records standards. Results of these findings are shared with the practitioner. The Regional Medical Director is involved with the overall finding, as well as providing medical expertise in interpreting any questionable standard of practice.

FIRSTCARE has established patient safety and member confidence in the quality of health care they receive from our Plan providers, as one of our primary goals and essential to continue being "the HMO of Choice" in Texas.