Federal Employee Health Benefits

Piedmont Community Healthcare Patient Safety Initiatives

HIGH DEDUCTIBLE HEALTH PLANS
Piedmont Community Health Plan is working on its HSA plans. These are not currently available to be included with this proposal.

PHARMACY BENEFIT MANAGEMENT ARRANGEMENTS
Piedmont Community Health Plan contracts with a PBM currently. That contract is reviewed on an ongoing basis to ensure competitive discounts and pricing. In fact, our contract was just renegotiated to apply more competitive pricing. We routinely perform our own internal audits.

CARE MANAGEMENT PROGRAM

1. Piedmont Community Health Plan (PCHP) is continuing its multi year initiative to improve care for diabetic patients. The Plan uses claims and pharmacy data to profile patterns of care delivered by primary care physicians to their diabetic patients, including frequency of office visits, measurement of necessary laboratory studies and referrals for specialty care services such as dilated eye examinations. Each network primary care office receives information comparing allowing comparison to other offices. PCHP has seen substantial improvement in diabetic care patterns in the last three years. In 2003 PCHP began on-site reviews of diabetic patient records at selected primary care offices to gather and report back more specific comparative data, including laboratory results, that cannot be obtained from claims data.

   In 2003 PCHP began a pilot diabetic disease management program. Utilizing a certified diabetic nurse educator, PCHP has used claims and office chart data to identify high-risk diabetic patients who have not been complaint in their diabetic care. These patients are contacted directly by PCHP, working in conjunction with their primary care physician, to identify and overcome obstacles to better care. Higher risk diabetic patients are provided intensive diabetic education. In some instances PCHP, with the financial support of the patient's employer, has contracted with diabetic patients to provide financial assistance for uncovered medical services (office and medication co-pays, glucometer strips) in exchange for documented compliance by these patients. PCHP's diabetic disease management program has experienced some remarkable success and is being expanded in 2004

2. PCHP continues its three year campaign to lessen unnecessary antibiotic use in upper respiratory infection. By using claims and pharmacy data to profile network physicians usage and selection of antibiotics and by presenting comparative information back to network physicians, PCHP has noted a steadily declining level of antibiotic usage in upper respiratory infection by network physicians. Central Virginia rates that compare very favorably to national and regional data. PCHP has worked together with the Centra Foundation to sponsor a public relations campaign in Central Virginia to increase public awareness of the importance of judicious use of antibiotics. Because of its success, PCHP has been asked to work with the Commonwealth of Virginia Health Department to further their statewide campaign.
3. In 2000 PCHP began a campaign to increase screening mammography rates for women covered under the Plan. Using yearly claims data, PCHP has identified eligible women who have not undergone mammography. These women have been sent reminders and educational material to encourage regular mammography. PCHP has worked with Centra Health's mammography program to heighten public awareness of the need for mammography. PCHP has noted a 17% increase in mammography for eligible women in the last four years to an annual rate of 55%, comparing very favorably to national benchmarks.
4. In 2003 PCHP formed network physician work groups to develop and implement guidelines for the use of certain costly new diagnostic and therapeutic procedures available in the community, including Positron Emission Tomography (PET scans), Hyperbaric oxygen treatment of wounds, Polysomnography (overnight sleep studies) and Bone Density testing. PCHP now employs these guidelines to ensure efficient and cost effective use of these procedures.
5. In 2004 PCHP will implement a secure internet-based communication system between network offices and PCHP to improve the efficiency of referrals and to provide prompt information to office about patient eligibility and benefit coverage.
6. In 2004 PCHP will use claims and pharmacy data to profile prescription writing patterns of network physicians. Working with its pharmacy benefit company, Advance PCS, PCHP will promote the highest possible utilization of cost- effective generic drugs and will promote selection of cost effective therapeutically equivalent trade name drugs when an option exists.
7. In 2004 PCHP is working to develop a claims-based health risk assessment report for network employers, providing information about utilization of preventive health services and providing information about the frequency and cost of certain diseases for which preventive health measures can be of use. PCHP intends to establish a dialogue between different PCHP employers to promote best practices in wellness/preventive healthcare and disease management, including development of employer incentives toward lifestyle modification to promote better health.

PATIENT SAFETY
Piedmont Community Health Plan reviews all primary care and specialty offices within its network on a biannual basis to identify any problems with the office environment, including facilities and administrative/clinical practices, that could represent a safety hazard to patients.

Piedmont works together with its pharmacy benefits manager and with its hospital providers to support safety initiatives with regard to medication uses and hospital care. The PBM's process begins with pharmacy's entry of a prescription into the pharmacy computer system, leading to a system check of this prescription against any other active medications of file within the last three months. The following reviews are conducted:

• Drug-Drug interactions
• Drug-Age conflict
• Drug-Disease conflict
• Drug-Allergy conflict
• Drug-Gender conflict
• Drug-Pregnancy warning
• Excessive controlled substance utilization
• High dose warning
• Ingredient duplication
• Therapeutic duplication

Any abnormality is communicated to the prescribing physician for further review and discussion with the patient.

Piedmont has been active in reviewing and analyzing antibiotic usage in respiratory infection for its members. Piedmont has profiled network primary care physicians regarding antibiotic prescription frequency and choice and provided each physician this information. Piedmont has provided written educational material to members about safe use of antibiotics in respiratory infection. Piedmont continues a public relations campaign with the community at large to promote safe use of antibiotics in respiratory infection. Piedmont will continue to measure antibiotic usage and antibiotic resistance rates within the community as outcome measures.