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    Healthcare Plan Information

    Lovelace Health Plan Patient Safety Initiatives

    Question Answer
    1. Do you have a specific patient safety officer? What office/position oversees this? The Lovelace Health Plan does not have a specific patient safety officer however, patient safety is a key priority of the Clinical departments of the Health Plan. The Lovelace Medical Director, along with the Lovelace Directors of Health Services, Quality, Pharmacy and Appeals and Grievances, monitor, investigate, and track member safety issues.
    2. Drug utilization reviews. In non-technical terms, explain the systems you have in place to identify (retrospective) and prevent (concurrent) prescription drug errors. The Lovelace Health Plan Pharmacy System checks for prescriptions exceeding the maximum dose and for duplication of therapy. The system also reports refills that are requested too early, which can be used to monitor over-utilization of medications such as beta antagonist inhalers by asthmatics.
    3. Disease Management Programs. What programs do you offer, and what could a prospective patient expect to receive generally in terms of education, treatment, and follow-up? The Lovelace Health System has been a leader in the development of disease management programs through its "Episodes of Care" program. Episodes of Care has focused on providing assistance to physicians who are managing chronic diseases through evidence-based guidelines and resource materials.

    The Lovelace Health Plan is building on their program by expanding disease management to include a member-centric focus. Over the next six months, Lovelace Health Plan will implement programs addressing diabetes, asthma and cardiac disease. Depression, as it relates to these three conditions, will also be a focus.

    Members participating in the disease management program will receive one-on-one personal attention from a specially trained nurse and RN, along with educational materials which will be mailed to their homes. The nurse will also keep in close contact with the member's treating physician and assist in coordinating treatment plans.
    4. Do you issue evidence-based guidelines to doctors for treatment recommendations? The Lovelace Health Plan issues evidence-based guidelines to physicians. These range from the Lovelace developed Episodes of Care guidelines to guidelines developed by national organizations and specialty societies.
    5. Do you share individual patient prescription drug profiles, or patient disease profiles with the patient's doctors? Lovelace Health Plan distributes aggregate Physician Prescription profiles and HEDIS Primary Care Provider (PCP) Profiles on a regular basis. HEDIS Primary Care Provider Profiles (referred to as Provider Action Reports) are completed and sent to Primary Care Providers (PCPs) each year that show the PCP their individual HEDIS rates for select HEDIS measures, based on members assigned to them for the current reporting year. Also shown is each PCP's trend, by HEDIS measure, over the past three measurement years, and how that trend compares to National HEDIS rate averages. The selected HEDIS measures are chosen based on their relevance to preventive practice (for adults and children,) and because they are measures that have remained fairly stable per HEDIS criteria for the past 2 to 3 years.

    For select disease states (those that have been targeted for quality and/or disease management initiatives,) PCPs have also been sent lists that highlight those individual members in their panel with the selected disease diagnoses. In 2002, these lists included members with asthma, diabetes and/or depression, by product, and were sent with materials to facilitate provider compliance with adopted care guidelines for these disease states.

    The Lovelace Health Plan will distribute individual member prescription drug profiles when requested by the physician.
    6. Do you routinely include patient safety information in physician newsletters? The Lovelace Health Plan provides newsletters that routinely contain drug safety information.
    7. Do you have a physician or hospital quality service or recognition program? The Lovelace Health Plan does not currently have a provider quality recognition program.

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