Federal Employee Health Benefits

Blue Cross of California Patient Safety Initiatives

Blue Cross of California's continued efforts to improve health care quality and member satisfaction include the patient safety related measures outlined below.

LEAPFROG

Blue Cross of California is very supportive of the goals of the Leapfrog Group's efforts to promote patient safety and to reduce medical errors for hospitalized members. In California the Pacific Business Group on Health (PBGH) is championing this effort. Blue Cross' corporate medical director is a member of the PBGH Medical Advisory Committee. Blue Cross does not currently mandate participation in the Leapfrog database in our hospital contracts nor do we independently track hospital compliance with Leapfrog and/or provide incentive reimbursement for hospitals that meet the Leapfrog standard(s). We do encourage hospitals to complete the survey by endorsing PBGH's efforts and by personally contacting key Blue Cross contracted hospitals that do not complete the survey.

The Leapfrog initiative recommends that hospitals initiate three safety measures as follows:

• Computerized physician order entry (CPOE)
• Physician on intensive care unit staff
• Report volume/outcomes measurement for selected procedures

The Leapfrog initiative has taken a firm root in California and so far 175 hospitals have participated in the survey. Detailed results of the PBGH California hospital survey are available for consumers at PBGH's Consumer Health Information web site, www.healthscope.org, and information for all regions are available at www.leapfroggroup.org.

A revised version of the Leapfrog Survey questionnaire was made available in April 2003. The new questionnaire has been updated and improved with input from such industry leaders as the American Hospital Association and the Joint Commission for Accreditation of Healthcare Organizations. The most significant change to the survey involves the evidence-based hospital referral (EHR) leap, which currently uses procedure volume as a proxy for patient safety performance. The updated survey uses actual performance measures for the EHR leap and awards hospitals partial credit for intermediate procedure volumes. The new survey also includes more ways for hospitals to be awarded credit for CPOE systems.

To ensure that only the most current information about participating hospitals is presented to consumers, all existing Leapfrog hospital survey results were deleted from the Leapfrog web site on July 1, 2003 and replaced with responses to the revised survey.

After July 1, 2003, only updated survey results are posted on the Leapfrog website, HealthScope and other consumer health information web sites. PBGH is gearing up for a push to encourage hospitals to update their Leapfrog information using the new survey questionnaire.

The Leapfrog Survey is endorsed by the following California health plans: Aetna, Blue Cross of California, Blue Shield of California, Cigna, HealthNet, Kaiser Permanente and PacifiCare. The medical directors of these health plans strongly encourage all hospitals in California to participate in the Leapfrog Patient Safety Survey and they sent letters to the CEOs of hospitals that did not respond to PBGH's appeal by June 1, 2003.

Blue Cross has also agreed to support the efforts of the California Institute for Health Systems Performance (CIHSP)/California Healthcare Association (CHA) collaborative to assist hospitals in reducing medication errors.

HEALTH IMPROVEMENT (DISEASE MANAGEMENT) PROGRAMS)

Blue Cross of California offers health improvement programs (disease management programs) to our members with asthma, diabetes, congestive heart failure (CHF) and/or cardiovascular disease (CVD), cancer and musculoskeletal conditions (rheumatoid arthritis, osteoarthritis, and low back pain). Our health improvement programs (HIPs) provide an innovative, interdisciplinary approach to helping members manage their chronic conditions. Our Baby Connection program is also available to prenatal members. All of our HIPs and Baby Connection are coordinated and administered completely in-house.

Our programs involve an individualized approach and utilize one-on-one communication with each participant to assess individual needs. Members work with a team of health care professionals - led by a registered nurse acting as a "health coach" and including their personal physicians - to achieve health and lifestyle goals. Participation in our HIPs is always voluntary.

HIPs are a high priority at Blue Cross of California. We have made a substantial investment in expanding these programs across our membership, including the implementation of three key components:

• disease registries to track the health improvement activities and outcomes for members
• a unique web-based information platform for our health coaches (our name for disease managers)
• A health-coaching model that focuses on members' abilities to learn new self-care behaviors

All of our HIPs are designed to achieve the following goals:

• Improved quality of life
• Decreased resource utilization
• Increased satisfaction
• Better adherence to treatment plans
• Fewer missed workdays
• Higher productivity

Current Programs

Our current Health Improvement Programs are:

• Asthma

• Cardiovascular Disease

• Congestive Heart Failure

• Depression Screening

• Diabetes

• Musculoskeletal Program

• Obesity Screening

• Oncology Support

• Baby Connection

CENTERS OF EXPERTISE

Blue Cross recognizes facilities that have distinguished records for highly specialized organ transplants and have established programs for heart, lung, heart-lung, liver, simultaneous pancreas-kidney, bone marrow transplantation, and coronary artery bypass grafting (CABG) involving designated facilities.

GUIDELINES FOR TREATMENT RECOMMENDATIONS

Blue Cross of California adapts or adopts guidelines that are evidence-based and endorsed by national specialty societies or associations such as the National Diabetes Association, U.S. Preventive Health Services Task Force, and the American Academy of Pediatrics. Guidelines are reviewed prior to approval and implementation by an expert panel of physicians convened by Blue Cross.

PHARMACY-BASED PROGRAMS

Pharmacy Program

Blue Cross of California provides several programs designed to ensure safe and appropriate medication use. Included are programs which focus on members with high pharmacy utilization, pharmacy issues in the senior population, migraine management, asthma management, and the appropriate use of antibiotics.

• Asthma Pharmacotherapy Optimization Program (APOP)

  Blue Cross' Asthma Pharmacotherapy Optimization Program (APOP) was established to address the rising prevalence of asthma and reported poor rates of compliance and adherence to recommended treatment in the state of California.

  Our pharmacy management department joined forces with our health improvement programs to devise an intensive intervention strategy that improves controller use and will ultimately result in improved outcomes, reduced utilization of resources, and cost savings.

• Members-at-Risk Program

  Our Members-at-Risk Program identifies members whose prescription utilization patterns may put them at risk for adverse drug events. We target members who appear to have a high utilization of medications or a lack of coordinated care among providers. Sometimes it is difficult for physicians to monitor total drug therapy for members who see multiple providers, utilize the services of multiple pharmacies, or use many medications. Substantial risk to members and cost to the health care system may be avoided by preventing drug-related problems such as drug interactions, duplicate therapies, or drug overutilization.

• Seniors-at-Risk Program

  Our Seniors-at-Risk Program promotes the continuity and coordination of care for Blue Cross senior members with chronic diseases. Program objectives include monitoring pharmacy claims for evidence of polypharmacy and providing feedback to treating physicians for members who may be at risk for adverse drug interactions.

• Migraine Program

  The migraine program seeks to increase the use of migraine prophylactic therapy by identifying members with significant migraine drug claims history. Prescribing physicians receive letters or fax-back response form that outline recent related medical literature and summarize drugs commonly used for migraine prophylaxis.

• Judicious Antibiotice Use Program

  In support of the Centers for Disease Control (CDC) campaign against bacterial resistance, we identify physicians with a high utilization of antibiotics and send them a series of mailings during the cold and flu season. The mailing will consist of CDC supported patient education materials, Blue Cross of California antibiotic recommendations, and physician educational materials from the CDC.

Drug Utilization Review

Our standard drug utilization review program integrates prospective, concurrent and retrospective analysis to create an effective force enhancing the safety, appropriateness, and cost effective use of pharmaceuticals. Prospective review encourages selection of a cost-effective, therapeutically efficacious medication at the point of prescribing. Our on-line system provides pharmacists with concurrent review capabilities, referencing member pharmacy claims history and indicating potential drug interaction information and formulary therapeutic recommendations. Retrospective review uses drug utilization data gathered from our database to target patients, physicians, and pharmacists who are non-compliant with formulary and other clinical programs.

Primary Care Physician Notification Program

This program is one component of our patient safety initiative. Primary care physicians receive a list of their Blue Cross members who have chronic diseases and who are taking psychotropic medications prescribed by a psychiatrist. Other pharmacy based safety initiatives include point of sale edits to prevent adverse drug interactions.

PHYSICIAN AND HOSPITAL QUALITY

PMGs/IPAs

Blue Cross of California evaluates its contracted PMGs and IPAs annually. Results are compiled into performance profiles which are available to members on our website. Blue Cross offers a quality incentive bonus to health care providers based upon performance profile report results.

Hospitals

Blue Cross monitors hospital quality performance through a contract with Subimo. Detailed hospital quality performance is provided to members on our website. The profile includes a volume of major surgical procedures, complication rates, and patient satisfaction results for hospitals.

Subimo's knowledge base integrates diagnosis and procedure information with hospital data from publicly available state and federal agencies. This allows members to gather facts they may need before making decisions about procedures or treatments.

NEWSLETTERS

Blue Cross addresses patient safety in physician, member, and hospital newsletters and on our website.