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FEDERAL EMPLOYEE HEALTH BENEFIT PROGRAM: BCN PATIENT SAFETY

Blue Care Network has a Patient Safety Officer in place to assure that patient safety initiatives are taken throughout BCN and in collaboration with contracted practitioners, hospitals and other health care facilities. Patient safety expectations are communicated to practitioners and facilities routinely via newsletters, Professional Services and Facility manuals and BCN website. BCN also has a Patient Safety Committee in place to evaluate and address patient safety initiatives throughout BCN, and in partnership with contracted hospitals.

BCN member cases identified with potential quality issues are received in the Quality Management department from the Care Management and Customer Services department for investigation. The cases are reviewed by Corporate Quality Management Coordinators and forwarded to the Associate Medical Director, Quality Management for recommendation

Individual practitioners are notified when a potential quality of care/service concern is identified and given an opportunity to provide additional or clarifying information. Corrective action plans are requested as deemed appropriate by the Associate Medical Director, Quality Management. A copy of the completed quality investigation request form with outcomes and actions taken is placed in the practitioner's quality management file. Information related to physician's compliance with BCN quality standards is evaluated at the time of physician's recredentialing.

BCN Pharmacy Safety Initiatives - 2003

New Pharmacy Policies to Increase Member Safety

BCN introduced two new medication safety-related policies in 2003. BCN's new Controlled Substance policy will be implemented by the end of 2003 to assist primary care physicians with the management of their BCN members who are suspected of controlled substance misuse or who may require additional support for the management of pain medications.BCN Pharmacy Services will assist physicians who request restricted member access to controlled substance medications.

BCN also implemented a Drug Recall policy to help ensure appropriate notification of prescribers and members in the event of a Class I Drug Recall. A Class I recall is a situation in which there is a reasonable probability that the use of or exposure to a violative product will cause serious adverse health consequences or death.

Urgent FDA Warning:

When the Federal Drug Administration announces an urgent warning regarding medication safety or an urgent mandatory drug recall, the primary care physician is contacted regarding their specific members receiving the specific drug. On June 19, 2003, the Food and Drug Administration (FDA) issued an advisory regarding reports of a possible increased risk of suicidal thinking and suicide attempts in children and adolescents under the age of 18 treated with the drug Paxil® (paroxetine hydrochloride) for major depressive disorder (MDD).

BCN identified members under the age of 18 with pharmacy claims for Paxil. A notice was sent to each prescriber to remind them of the advisory and to provide member-specific claim information.

Life-Threatening Drug Interactions

Blue Care Network continues to work with its pharmacy claims processor to prevent potentially fatal drug interactions. Prescriptions resulting in a potentially life-threatening drug interaction for the member cannot be filled until the prescriber is contacted and a pharmacy claims override is approved. A Blue Care Network clinical pharmacist reviews these life-threatening drug interactions to ensure all necessary programming is accomplished to prevent life-threatening drug interactions from processing on our BCN claims system.

Pharmacy Quality/Safety Report: Prevention of Adverse Effects in Elderly Patients

During 2003, Blue Care Network moved into its third year of quarterly distribution of its physician-specific report designed to assist the PCP with the medication management of patients over age 65. This report identifies drugs that should generally be avoided in the elderly population, unless there is clear evidence that the potential benefit outweighs the potential risk for the specific patient. Elderly patients who require treatment with one of these drugs should be closely monitored for adverse effects.

Pharmacy Quality/Safety Report: Controlled Substance Abuse and Misuse

BCN's Controlled Substance Report is another key PCP-specific report that is distributed each quarter to help promote appropriate prescribing. This report identifies BCN members who had prescription claims for a total of nine or more controlled substances from three or more physicians using three or more pharmacies during a three-month period. These members may be at risk of drug dependence or abuse. This unique quarterly report allows the primary care doctor to ensure member safety and appropriate drug treatment. Physicians who receive these reports frequently contact Pharmacy Services with questions and to receive additional information regarding these members. These reports have provided critical prescription information not previously available to the primacy care physician.

BCN plans to expand its controlled substance reporting to identify members whose prescription claims reflect unusually large quantities of specific controlled substance medications.

Pharmacy Quality/Safety Report: Problem Prevention - Dangerous Drug Combinations

The Multi-Drug Review is the third report that was developed in late 2001 and has helped decrease the risk of drug interactions and adverse events. This quarterly report identifies members over age 55 who receive 11 or more different medications per three-month period. A clinical pharmacist reviews each medication regimen that meets these criteria and provides specific information regarding possible drug-drug and drug-disease interactions when potential issues are identified. The physician is asked to review the information and provide feedback or resolution. The number of changed drug regimens and the number members of who continue to appear on the reports each month have not been tabulated.

Pharmacy Quality/Safety Report: Problem Prevention - NSAID Safety Report

BCN's new NSAID safety report, first developed and distributed in December 2002, ensures balance to BCN's prior authorization guidelines for COX-2 inhibitors. BCN's criteria for the use of a COX-2 Inhibitor include age >60, use of concomitant glucocorticorticoids or anticoagulants, or other risk of gastrointestinal bleed. While BCN has been successful with this prior authorization program, their remains a concern over the possible over-use of traditional NSAIDs in patients who might be at increased risk of GI bleed. This new report helps ensure that BCN members who are at increased risk of GI bleed to not receive chronic treatment with a traditional NSAID.

Pharmacy Quality/Safety Report: Maximum Dose Exceeded

BCN developed and distributed a Maximum Dose Report to decrease the potential risk of adverse drug events for its members. BCN worked with ValueOptions, BCN's contracted mental health provider to identify the list of psychotropic drug dosage amounts that should not be exceeded. Patients were identified who received doses of psychotropic medications that exceed the manufacturer's recommended daily dose. The member-specific pharmacy claims information and a chart that identifies the maximum daily dosage of the psychotropic medications reviewed were mailed to each prescribing physician. BCN also distributed member Atrial Fibrillation and Anticoagulation reports to Primary Care Physicians during the second quarter of 2003.

BCN participates with the Michigan Health and Safety Coalition (a voluntary collaborative quality improvement effort focused on improving patient safety in Michigan), and the Leapfrog Group (a national non-profit organization representing purchasers). Both organizations are committed to improving patient safety and the quality of health care.

In 2003, the Michigan Health and Safety Coalition (MH&SC) and The Leapfrog Group in a joint effort developed a hospital patient safety survey. The goal of the survey is to evaluate hospital's commitment to improving patient safety for consumers and purchasers in Michigan and across the country. Hospital participation in the surveys was voluntary, but participation was strongly encouraged so that both the MH&SC and Leapfrog can better achieve their goal to improve the safety of patient care in Michigan hospitals. Hospital results reported in 2002 were shared with the healthplans during the first quarter of 2003.

During September 2003 hospitals throughout Michigan were asked to complete the on-line surveys on the following areas of care: Open Heart Surgery, Percutaneous Coronary Intervention, Abdominal Aortic Aneurysm Repair, Carotid Endarterectomy Surgery, Pancreatic Resection, Esophagectomy for Cancer, Low Birthweight Infants and Infants with Congenital Anomalies in NICUs, Intensive Care Unit Physician Staffing, and Computerized Physician Order Entry. Information from the surveys provides comparative data for hospitals and assists hospitals with identifying and implementing patient safety best practices. The reported information will be analyzed in December 2003.

BCN recognizes hospital performance through incentives. One of the efforts BCN is undertaking is to migrate contracted hospitals to a Participating Hospital Agreement (PHA) Incentive program that rewards hospitals for performance improvement in utilization, quality of care, and medication safety. This program encourages improvement in utilization and safety, and emphasizes the quality of care.

Office site visits are conducted on primary care practitioners, obstetricians and gynecologists prior to credentialing and every two to three years to encourage a safe environment for members.

Member, practitioner, provider and employee patent safety education is conducted through newsletter articles, BCN web site, committee presentations and communication at meetings.

Evidence based clinical practice guidelines including pharmaceutical ]prescribing guidelines have been developed for high volume, high cost diagnoses. Guidelines are distributed to practitioners via newsletters, manuals and BCN website. Performance measures were established for each guideline and monitoring compliance with guidelines is completed.

Interplan Safety Council

The Interplan Safety Council is a collaborative initiative among health plans to promote implementation of Michigan Health and Safety and LeapFrog Group patient safety standards in contracted urban hospitals. The health plans have worked together to educate hospitals on the three major standards: 1) Computerized physician order entry systems; 2) Intensive care physician staffing and 3) Evidence-based hospital referral systems.

In 2004, the Interplan safety council will continue to develop collaborative initiatives for promotion of patient safety.