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    Healthcare Plan Information

    Altius Health Plans Patient Safety Initiatives

    Patient Safety Officer: The patient safety officer for the members of Altius Health Plans is Dr. Dennis Harston. Dr. Harston is the Chief Medical Officer and reports directly to the President of the company. The broad, overall goal of the patient safety program is to promote the provision of high quality, effective, and cost-efficient member care. Critical components of the member safety program include the following:

    • Case Management of high risk, complex, and chronically ill patients is provided by qualified nurses, with physician oversight, to assure that health care services received by these patients are of high quality and conform to all standards of conventional and established medical practice.
    • Disease Management Programs are provided to members with conditions including diabetes, congestive heart failure, asthma, and pregnancy. The goals of these programs are to promote patient understanding and compliance, and to improve communication between patient and health care provider.
    • Concurrent Hospital Review is provided on all institutionalized patients insured by Altius Health Plans. Qualified nurses conduct this review daily. The reviews are made to assure that in-patient care and its consequences are monitored for quality of care and outcomes.
    • Review by the Altius Quality Management Department of reports of questionable care reported by Altius members, quality review nurses, and utilization review nurses. Corrective action as needed.
    • Review of all High-Volume Primary Care Physicians for quality of care standards including member satisfaction, unusual number of bed days, caesarian section rates, complaints, and appointment availability. Feedback related to his or her performance in comparison with that of his/her peers is provided to the reviewed physician.
    • Annual Survey of Member Satisfaction, as well as several focused satisfaction surveys, with comments provided to the affected department or provider. This survey probes the member's perception of primary and specialty care received, quality of the provider or provider office, communication, and health plan service issues.
    • Annual Survey of Physician Satisfaction, completed by an independent surveying agency. These surveys have provided meaningful input regarding perceived concerns with health plan policy and medical management programs.
    • Periodic Drug Utilization Reviews conducted in conjunction with Express Scripts, a pharmacy benefit management company. Altius reviews areas such as the use of controlled substances, the treatment of asthma, the treatment of depression, the use of antibiotics, the treatment of diabetes, the treatment of anemia, potential drug-drug interactions, and risks from multiple medications. The goals for the reviews are to identify areas for patient or physician education, promote compliance, or to reduce risks.
    • Evidence-Based Guidelines for children and adults are actively promoted to both members and physicians. These guidelines encourage regular medical checkups and indicate the recommended interval for each type of preventive care. Annual compliance is measured, with interventions when necessary.
    • Pharmacy Step Therapy Programs to promote the use of safer first line drugs before the use by our members of higher cost, higher risk second line agents. These programs are primarily for the treatment of pain, acne, anemia, erectile dysfunction, osteoporosis, cancer, allergic rhinitis, depression, and arthritis.
    • Communicating Relevant Updates to Providers on the Website is the preferred method of communication. Notices are posted on a Provider Message Board in the dedicated website channel for providers.
    • Recognition of the Top 10 Percent of Providerswho excel at member service and care. Providers are sent a letter signed by executive management recognizing and commending their performance.
    • Contracts with JCAHO-accredited hospital facilities that have Quality Management staff, and that support and participate in patient safety initiatives.
    • Altius is URAC Accredited – URAC measures performance based on nationally accepted standards. URAC accreditation demonstrates a standard of excellence. URAC is an independent nonprofit organization committed to promoting health care quality through accreditation and certification

    As a result of the Patient Safety Initiatives, Altius expects to see the following outcomes:

    • Fewer reported adverse quality of care events or concerns
    • Improved member awareness of disease
    • Improved member satisfaction with care
    • Reduction in hospital costs related to complications of any aspect of giving care
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