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    Healthcare Plan Information

    Piedmont Community Healthcare Patient Safety Initiatives

    Piedmont Community HealthCare contracts with a PBM for its prescription drug benefits. This contract is reviewed on an ongoing basis to ensure competitive discounts and pricing. We routinely perform our own internal audits.

    Complex Case Management is a free program that helps members of Piedmont Community HealthCare, who have complex or multiple conditions, manage their health issues so they can be as healthy and active as possible. The Piedmont Nurse Case Manager (NCM) will offer support, but you ?the member ?will ultimately need to take a more proactive role in making healthy changes. Making these changes and following your doctor�s plan of care will improve how you manage your health conditions and take care of yourself each day. The program is entirely voluntary. Your decision whether or not to participate will not affect your insurance coverage. If you decide to participate, and later change your mind, you can leave the program at any time. What can I expect? The NCM will work with you and your doctor, or nurse practitioner, to help you manage your health conditions. This can be done by telephone or pre-arranged contacts. The NCM will also provide education, resource assistance and help in navigating the complex healthcare system. You will continue to see your doctor, or nurse practitioner for medical care. Contacts can be made as frequently as necessary to assess your progress. How will the program help me? The Complex Case Management program will assist you in the ability to manage your health conditions and take care of yourself. If you choose to involve family members or care-givers, we can help them to better understand your conditions and needs. The NCM also helps you make appropriate decisions about your care and ensure that you are receiving the right services and the right support. Your Piedmont NCM may make appropriate recommendations on subjects such as: Preventive care programs; Mental Health programs; Lifestyle programs such as nutrition, smoking cessation and weight management; Community resource assistance, rehabilitation, skilled nursing and home health services. Let us support you as you learn to live better with your health conditions.

    Healthier people have fewer health claims and fewer claims can help to lower health plan costs. At Piedmont we have developed an effective health management program. Piedmont�s individual Case Management Programs address specialized wellness needs and include a diabetic disease management program, a prenatal maternity program, a behavioral health program and a tobacco cessation program (Tobacco cessation program must be coordinated by employer). By participating in these more intensive educational programs certain people who may be �at risk?can learn better ways to further their healthcare management goals. Individuals can be referred by their physician, identified through medical claims history, or volunteer for these programs.

    1. �LEARNING ABOUT DIABETES? The Diabetic Case Management Program is a proactive health initiative designed to assist diabetic members with managing and controlling their diabetes. The program objectives are to reduce incidences of chronic and disabling diabetic complications through a combination of early education and improvements in lifestyle such as exercise and diet. Piedmont utilizes an in-house certified diabetic nurse educator.
    2. �HEALTHY BUNDLES?MATERNITY PROGRAM: The �Healthy Bundles?Program is our case management plan to promote healthier births. Its objective is to reduce the severity and incidence of pre-term births. This is accomplished through early prenatal education and intervention to assist participants in understanding their condition and the vital role the expectant mother plays in her own personal health and that of her unborn baby.
    3. �NAVIGATING LIFE?BEHAVIORAL HEALTH: The Behavioral Health Case Management Program is meant to assist and support those members receiving mental health services through education and utilization of available community resources. The objective is to ensure quality health care and enhance the member�s quality of life. The program serves as a complement to the physician/counselor/patient relationship by early identification of members who might be at risk of behavioral disorders.
    4. �READY, SET, QUIT?SMOKING CESSATION: The Tobacco Cessation Program is for members who recognize the importance of a tobacco free lifestyle. Components of the program routinely include a personal assessment, incentives for completion, physician consultation, educational classes, coverage for nicotine replacement if recommended, and compliance testing. We work with each employer to customize and implement a program to work with their individual group.

    Piedmont Community HealthCare reviews all primary care and specialty offices within its network on a biannual basis to identify any problems with the office environment, including facilities and administrative/clinical practices, that could represent a safety hazard to patients.

    Piedmont works together with its pharmacy benefits manager and with its hospital providers to support safety initiatives with regard to medication uses and hospital care. The PBM�s process begins with pharmacy�s entry of a prescription into the pharmacy computer system, leading to a system check of this prescription against any other active medications of file within the last three months. The following reviews are conducted:

    • Drug-Drug interactions
    • Drug-Age conflicy
    • Drug-Disease conflict
    • Drug-Allergy conflict
    • Drug-Gender conflict
    • Drug-Pregnancy warning
    • Excessive controlled substance utilization
    • High dose warning
    • Ingredient duplication
    • Therapeutic duplication

    Any abnormality is communicated to the prescribing physician for further review and discussion with the patient.

    Piedmont has been active in reviewing and analyzing antibiotic usage in respiratory infection for its members. Piedmont has profiled network primary care physicians regarding antibiotic prescription frequency and choice and provided each physician this information. Piedmont has provided written educational material to members about safe use of antibiotics in respiratory infection. Piedmont continues a public relations campaign with the community at large to promote safe use of antibiotics in respiratory infection. Piedmont will continue to measure antibiotic usage and antibiotic resistance rates within the community as outcome measures.

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