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    Healthcare Plan Information

    Physicians Health Plan of Northern Indiana Patient Safety Initiatives

    Physicians Health Plan is committed to community outreach. We are a not-for-profit managed care insurance company that believes in and supports the doctor-patient relationship. We focus on preventive care and are committed to having a positive effect on the communities we serve.

    Many initiatives are underway within the community to enhance the effectiveness and efficiency of patient safety as part of quality improvement efforts and accreditation standards in regional hospitals and provider groups. These areas focus on the total package of patient safety with collaborative efforts of our provider community.

    Emphasis has been placed on programs and measurement tools for Provider Relations, Utilization Review/Case Management, Prescription Management, and continued Employee Health Education. We currently do not appoint a patient safety officer within our organization.

    Our Prescription Management Program uses a variety of tools to continue managing a member's pharmacy utilization. Our Drug Usage Evaluations (DUEs) is a program conducted annually by PHP's Pharmacy and Therapeutics Committee to set an action plan for the proceeding year. It is targeted towards provider education and is based on the member's utilization of prescription medication. We identify where a patient's utilization of medications may be harmful to them. In addition, we send notifications to various providers based on recommendations as reported from the Food & Drug Administration on clinical judgments or recalled products. Also, we include a cooperative program administrated by PHP for certain medications that are identified as available for coverage under the plan only when other medications, identified by the plan as appropriate for use, have been utilized by the member first. This helps provide an avenue to alternate medications over utilization of high cost medications. The identified medication products and the process are subject to periodic review and modification.

    As well as the programs mentioned above, PHP is pleased to have "AlertCare" that has been tracking prescriptions in our pharmacy claims system since January 1, 1994. This program monitors prescriptions within the PHP network of pharmacies before they are dispensed. Many times individual pharmacies are only able to review prescriptions filled in their own store(s) to identify potential drug related problems. By using our central database of claims, PHP can consider prescriptions from multiple pharmacies. This program also evaluates certain drug interactions as potential problems. The computer program alerts the pharmacist, who can assess whether two medications may be taken together, or if two medications with similar effects have been prescribed, when only one may be necessary. Also, the computer will inform the pharmacist if a medication and dose should be avoided if a woman is pregnant, based on the person's age and gender. The pharmacist will then communicate with the physician, as needed, to avoid or resolve any issues.

    PHP offers disease specific education for Asthma, Diabetes, and high Cholesterol. If you have been diagnosed with Diabetes or high Cholesterol you will be asked to participate in a two year educational program during which time you will receive monthly education and communication to assist you in managing your disease.

    In the last three years PHP has reported a 5%-10% increase in achieving the Health Plan Employer Data and Information Set (HEDIS) Recommended Medication Guidelines for Asthma medication, this increase exceeds the nationally reported levels of other HMO's.

    PHP provides continuous education to your Physician to assure your care is managed according to Nationally Recommended Guidelines regarding medication and diagnostic testing.

    It is our continued commitment to look for strategies to improve our current processes and preserve the community's access to quality and affordable health care.

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