Federal Employees Health Benefits

Triple-S Inc. Patient Safety Initiatives

Triple-S, Inc. recognizes the importance of addressing Patient Safety issues not only for the benefits it provides to patients quality of life but it also represents a higher cost to plans if not attended.

Patient Safety initiatives are managed by our Medical Affairs Division by a group of highly trained professionals in alliance with our PBM (Pharmacy Benefit Management).

In meeting Patient Safety concerns, a description follows of our Patient Safety activities that we want FEHB plan members to know about:

Systems Edits

To minimize prescription errors, our pharmacy claims system includes dose check edits that verify; correct dosage, daily maximum allowable dosage and drug interactions. This point of service system alerts the pharmacist at the moment of dispensing so any error may be corrected.

Physicians Orientations

We continuously provide information to our physicians on Patient Safety concerns and initiatives through bi monthly publications to our network physicians: PULSO and PHARMA NEWS.

Evidence Based Guidelines

During year 2002 and 2003 our Disease Management Asthma program developed evidence-based guidelines which were distributed personally to physicians with high volume of asthma patients and whose prescription practices were studied. This activity was performed in alliance with our PBM pharmacists who visited these physicians and reviewed prescription best practices with them. A subsequent analysis of prescription profile will be performed to evaluate impact of this activity in prescription practices. Similar activities will be performed in the future for diabetes management and other conditions.

Disease Management

Triple-S' Disease Management Program offers plan members education and follow-up in order to optimize your quality of life through the early management of risks or exacerbations. These programs have been designed to provide an integral approach to the rendering of these services through patient and physician education and involvement, the promotion of optimal drug utilization, as well as the provision, through the Case Management Program, of additional services that may not be covered by the plan.

The Disease Management Program at present, targets asthma patients and pregnant women. Interventions are done by telephone and educational written materials are sent to reinforce the learning experience. Through the Disease Management Program, plan members learn to develop the necessary skills to identify exacerbations risks and self-manage their conditions. Group interventions in the workplace are also offered. Program staff includes registered nurses trained in respiratory conditions and prenatal care, health educators, a respiratory therapist and a nutritionist. Physicians receive notification of patients' enrollment in the programs. Continuing education activities are offered to physicians related to the conditions managed by these programs.

Satisfaction surveys are completed by participants after completing any of the programs.

Network Quality Assurance

In our efforts to comply with all the standards established by the different accrediting agencies and to assure the quality of clinical services to our FEHB plan members, our credentialing processes for our providers verify credentials electronically with primary sources such as NPDB ("National Practitioner Data Bank"), the American Board of Medical Specialties and the National Technical Information Service, among others. We have a rigorous process to select and evaluate practitioners and institutions to be included in our network. Since 2000, we implemented the HIPDB ("Health Integrity Protection Data Bank") requirement of reporting the cancellation of contracts due to fraud or abuse. We also have well defined policies and procedures, which specify the requirements for participation in our network.

Since September 2001, we have redefined our credentialing process to comply with NCQA standards and our physician network has been recredentialed as of December 31, 2003.

Triple S only approves payment for professional services provided within the practitioners' scope of knowledge, experience and competence according to their credentials on a fixed fee schedule.

All of these processes contribute to a highly qualified network at the service of FEHB plan members.