Practice Guidelines

HMSA works with local physician reviewers to select clinical practice guidelines. Reviewers look at current, evidence-based guidelines for prevalent clinical conditions that affect patient care nationally and in Hawaii.

- Evaluate and improve quality care.

- Provide an educational reference for physicians.

- Clinical references are reviewed at least once a year to ensure that guidelines are current and reflect evidence-based practice.
Clinical references are cited.
- Some guidelines may be evaluated through program-specific measures, such as HEDIS.

Provider Quality & Service Recognition Program (PQSR)
Recognizes physicians who deliver excellent service-oriented clinical care.

- Improve physician performance in patient satisfaction and clinical quality of care.

- Reports to physicians include scores in four areas: quality indicators, practice patterns, patient satisfaction, and business operations.

Hospital Quality & Service Recognition Program (HQSR)

Recognizes hospital performance in quality of care, safety, and physician and patient satisfaction.

- Improve hospital performance in quality of care, patient safety and satisfaction.

- Expected vs. observable hospital outcomes include quality indicators for fewer complications, process of care, JCAHO measures, and provider and patient satisfaction.
- Recognition award reviews quality initiatives, with additional emphasis on patient safety programs.

AllScripts

Promotes electronic prescribing among physician network.

- Reduce medication errors due to illegible handwriting.

- Provide physicians with immediate access to drug reference for formulary decisions, indications, usage, and warnings and precautions, including contraindications, drug interactions, and adverse reactions.

- Handheld (IPAC) computers enable physicians to prescribe at the point of service and reference drug information.

Managing Your Medications

Annual one-month campaign encourages people taking multiple medications to have their medications reviewed by a pharmacist, and to learn about the use of prescription, over-the-counter medications, vitamins and herbal remedies.

- Improve the proper use of medications.

- Address concerns about drug interactions, adverse reactions, and other safety issues associated with multiple prescriptions.

- All reviews are confidential.

- Participants complete a satisfaction survey after their medication review.

- Data is used to evaluate the effectiveness and value of the campaign to the community.

Appropriate Use of Antibiotics

Educates the community, members and health professionals on the use of antibiotics and consequences of anti-microbial resistance.

- Reduce the rate of inappropriate prescribing of antibiotics.

- Increase community awareness of the consequence of inappropriate antibiotic use.

- Quarterly reports are sent to physicians who prescribe antibiotics for viral diagnoses.

- Rate of antibiotic prescribing is tracked and evaluated for improvement over time.

Laboratory Values Pilot

Partners with lab providers to make patient lab values available in a format that helps physicians manage patient information.

- Provide physicians with a population-based patient report that indicates underuse of lab services and allows for improvement.

- Physician-specific reports of their patient population serve as the basis for the intervention.

- Population results are monitored and evaluated for improvement over time.

American Heart Association (AHA) "Get with the Guidelines" (GWTG)

Implementation of AHA program by a coalition of community and treatment facilities to improve standards of care performance in cardiovascular disease.

- Facilitate education and support for implementation of GWTG program to improve cardiovascular care, treatment and patient safety in the hospital setting.

- Software program provides real-time feedback of hospital data to support rapid cycle improvement to best practice standards of care.

Concurrent Drug Utilization Reviews

Real-time pharmacy claims processor identifies potential drug interactions, therapeutic duplications, and high doses in medication therapies.

- Identify and reduce adverse events associated with drug interactions, duplications in drug therapy, and overdosage of medications.

- Pharmacists receive immediate messaging when the prescription is filled.

Migraine Medication Program

Designed to prevent migraine agent overuse by placing quantity limits.

- Increase appropriate use of medications for migraine attacks to avoid rebound headaches.

- Foster appropriate use of preventive medicine to help improve the overall management of the condition.

- Concurrent reviews are done when prescriptions are filled at the pharmacy.

COX II Program

Promote appropriate utilization of pain medication that are similar in efficacy to traditional non-steroidal anti-inflammatory drugs as evidenced by national guidelines.

- Promote appropriate use of COX II pain medications for members who require treatments with non-steroidal anti-inflammatory drugs who are at high risk for gastrointestinal bleeding.

- Concurrent reviews are done when prescriptions are filled at the pharmacy.

Narcotic Drug Review

Designed to prevent overuse, abuse, and/or diversion of narcotic drugs by identifying and evaluating member pain management regimens and directing members to assistance.

­ Foster appropriate use of certain narcotic drugs for members with chronic pain

­ Concurrent reviews are done when prescriptions are filled at the pharmacy.

Medications in the Elderly

Designed to identify members over the age of 65 who received a medication associated with changes in cognition and are at increased risk for falls.

­ Decrease the use of potentially unsafe and harmful medication in patients over the age of 65.

­ Physician reports identify the medication and patient.

­ Physicians may describe any actions taken.

Physician Utilization Reports Program

Reviews physicians’ formulary adherence and average cost of drugs relative to peer specialty. Drug formularies are determined by practicing community physicians.

- Promote better formulary adherence

- Promote medication regimens that are consistent with Best Practices.

- Physician-specific reports are tracked and evaluated for improvement over time.

Class I Drug Recall Program

Identifies and notifies members and prescribers affected by GDA Class I Recalls. These post-marketing recalls are initiated when drugs are found to pose a serious danger to health or cause death.

- Ensure member safety from potential harms associated with FDA Class I Recalls.

- Member and physician letters are sent within two weeks after HMSA receives knowledge of the recall.

Hypertension Compliance Program

Identifies physicians with patients not compliant with medication for hypertension.

Reinforces compliance by sending educational information to patients of the identified physicians.

- Improve appropriate use of hypertension medications .

- Quarterly physician-specific reports are tracked and evaluated for improvement over time.

HMSA’s Care Connection for

• Asthma and COPD

Complements practitioner treatment and self-care in members with asthma.

- Improve functional status, quality of life, and appropriate use of care services for members with asthma.

- Administrative data are used to evaluate program efficacy.

• Cardiac

Program provides services to members with coronary artery disease and/or heart failure and their physicians.

- Optimize health outcomes for members with coronary artery disease and/or congestive heart failure.

- Surveys for functional and health care outcomes and administrative data are used to evaluate program efficiency.

• Diabetes

Program assists members and their physicians to manage diabetes.

- More members with diabetes receive appropriate tests and care for early detection of complications.

- Decrease in rates for complications such as lower extremity amputation, ESRD, blindness and hospitalization.

- Surveys for functional and health care outcomes and administrative data are used to evaluate program efficiency.

Behavioral Care Connection

Helps members find appropriate mental health and substance abuse services and other special programs, such as smoking cessation.

- Foster appropriate care and optimal outcomes for members with behavioral health concerns.

- Surveys for functional and health care outcomes and administrative data are used to evaluate program efficiency.