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    Healthcare Plan Information

    Bluecare Network of MI Patient Safety Initiatives

    Patient Safety is one of the nation's most pressing health care challenges. Blue Care Network of Michigan is involved in many efforts to promote patient safety.

    BCN participates through the Michigan Association of Health Plans on the Michigan Health and Safety Coalition, a voluntary collaborative quality improvement effort focused on improving patient safety in Michigan.

    The Michigan Health and Safety Coalition (MH&SC) developed hospital referral guidelines to help support continuous improvement in the safety and quality of health care in Michigan. The guidelines focus on select areas of care, and provide recommendations for staffing, patient volume, data collection and continuous improvement initiatives.

    In September 2003, the MH&SC conducted an on-line survey of all Michigan hospitals. The results helped the coalition identify issues that need to be addressed before moving forward with implementing the guidelines, such as funding and access to care in different geographic areas. Blue Care Network of Michigan encouraged all of their contracted hospitals to complete the survey. The results can be found on the MH&SC website at www.mihealthandsafety.org.

    1. Program Summary
      • Encourage evidence-based medicine and the development of clinical practice guidelines.
      • Development measurements of outcomes and effectiveness of care by hospital and Physician.
    2. Annual quality improvement program plan focused on
      • Identification of important aspects of care and service
      • Quality of care and services delivered
      • Continuous improvement in the quality of care and services delivered
    3. Goals of the quality improvement program are:
      • Collaborate with state and local public health agencies
      • Develop, implement and evaluate evidence based clinical practice guidelines
      • Develop and implement practitioner profiles. Data includes member complaints, member satisfaction, conformance to clinical practice guidelines, conformance to health maintenance guidelines, rates on HEDIS measures, conformance to disease management guidelines and appointment access monitors.
      • Establish risk management and prevention programs to identify medical risk exposure, evaluate trends implement prevention programs and monitor results
      • Implement programs to improve processes and systems that impact member safety
    4. Clinical Practice Guidelines
      • Developed for high volume-high cost diagnosis
      • Include pharmaceutical prescribing guidelines
      • Promote the delivery of quality care and reduce variability in physician practice
      • Distributed to all physicians
      • Guidelines are evaluated every year and revised based on published national standards
      • Physician adherence to guidelines monitored annually
      • Outcome measures established and monitored for disease specific clinical guidelines
      • BCN has established a three year time frame for clinical practice guideline initiatives
    5. Collaborative Initiatives
      • BCN is participating in several collaborative initiatives in development and implementation of clinical practice guidelines
      • Michigan Quality Improvement Consortium - Diabetes , Asthma, Substance Abu
      • Michigan Association of Health Plans-"Taking on Diabetes in Michigan"
      • Alliance for Immunization in Michigan - Childhood - adolescent and adult immunizations
      • Michigan Association of Health Plans Asthma project -Asthma
      • South Central Michigan Health Alliance Polypharmacy project - identify members receiving five or more prescriptions within a three month period and develop interventions to reduce adverse effects
      • Michigan Antibiotic Resistance Reduction Program (MARR) -Promote appropriate use of antibiotics
    6. Measurement of Outcomes of Care of hospitals and physicians
      • Member Safety (Error Reduction)
      • Multidisciplinary work team to develop and implement member safety error reduction initiatives
      • Patient Bill of Rights distributed annually to members and physicians
      • Physician office site visits
      • Risk prevention programs for physicians and employees
      • Pharmacy review of iatrogenic drug effects
      • Notification to all physicians/members of drug recalls
      • Pharmacy and Therapeutics Committee
      • Collaborative initiatives with BCBS on error reduction in health care
      • Drug interaction prevention program
      • Ongoing member education regarding patient safety.
    7. The Leapfrog Group is a leading group of Fortune 500 companies and other large health care purchasers created and committed to drive patient safety in health care. The Leapfrog group identified three patient safety standards as a focus to measure hospital performance. To that end, BCN has entered into collaboration with other health plans to develop base line assessment and interventions in the three key areas of:
      • Computerized physician order entry
      • Intensive Care Unit physician staffing
      • Evidence based hospital referrals
    8. Performance Improvement Initiatives
      • Quality profiles for hospitals - BCBSM/BCN has developed a set of quality indicators for assessing and comparing hospital performance. Indicators include: satisfaction scores, performance/compliance with the three focus areas for patient safety; willingness to collaborate with BCN on performance improvement initiatives; severity adjusted mortality and morbidity rates; beta blocker treatment for AMI; ace inhibitor treatment for CHF and antibiotic use for management of community-acquired pneumonia. Information from the hospital profiles is used as part of the hospital contract.
      • Error Reduction - Blue Care Network collaborates with Blue Cross Blue Shield of Michigan to develop initiatives focused on error reduction in health care. The member safety program will continue to be developed according to the Institute of Medicine recommendations, requirements by the National Quality Forum and purchasers, and the anticipated addition of error reduction standards by regulatory and accreditation agencies.
      • Health Management Program Performance
      • Physician Recognition Program
      • Physician Profiles
      • Pharmacy Profiles
    9. Current data sharing initiatives
      • Data shared, in aggregate, with physicians and members
      • Results of HEDIS effectiveness of care measures
      • Member satisfaction results
      • Appointment access rates
      • Disease management outcome measures
      • Quality improvement study outcomes
      • Pharmacy quality improvement study outcomes
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