Harvard Pilgrim Health Care Patient Safety Initiatives for 2016

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1 Harvard Pilgrim Health Care Patient Safety Initiatives for 2016 Harvard Pilgrim conducts numerous activities to preserve and protect the safety of its members. The following is a summary of major patient safety activities for Medication Safety & Adherence - Harvard Pilgrim has a comprehensive and innovative Medication Safety & Adherence Program. The goals are to reduce the likelihood of medication errors in the outpatient setting, increase medication adherence and increase the awareness of members and practitioners about patient safety, adherence and the major sources of outpatient medication errors. The program has the following components: The Anticoagulation Management program is designed to reduce the risk associated with the use of warfarin, a commonly-prescribed blood-thinning medication that has long been known to cause potentially serious and preventable adverse drug events. Through dissemination of member educational materials, the program aims to improve the percent of members on warfarin whose blood levels are within the recommended guidelines. Using real-time pharmacy data, members newly started on warfarin treatment receive the educational brochure, Warfarin (Coumadin ): Taking your Medication Safely. Cardiac Medication Adherence - Members age 18 and older, recently hospitalized and discharged with a diagnosis of an acute myocardial infarction (AMI or heart attack), receive the educational brochure, Taking a Beta-Blocker for Life, that stresses the importance of staying on a beta-blocker long-term to prevent a secondary MI. In addition, a new Cardiac Medication Adherence Report report was launched in July, 2013 that notifies PCPs semiannually of their patients discharged after an AMI within the past two years and their six-month prescription fill history for cardiac medications. The goal of the report is to help PCPs identify non-adherence or discrepancies with a patient s cardiac medications and coordinate care with a specialist, if needed. Medication Reconciliation - The process of comparing a patient s list of current medications to a physician s discharge medication list - is known to be an effective way to reduce medication errors. Recognizing that patients just released from the hospital are at increased risk for adverse drug events, Harvard Pilgrim nurse care managers call members newly-discharged from the hospital and at potential risk and conduct medication assessments as part of post-discharge follow-up. The nurse care managers interview members to review drug regimens and ensure members understanding and compliance. The nurse care managers can consult with a Harvard Pilgrim clinical pharmacist about specific medication questions related to potential adverse drug reactions or interactions, and determine if additional follow-up with the member, or the member s practitioner, is indicated. Multiple Prescriber Report (MPR) is sent to providers who have patients with diabetes that are identified as having five or more prescribers of medications. The 1

2 goal of the program is to encourage coordination of care, communication between providers, and a thorough review of a patient s drug therapy to reduce adverse drug events and improve adherence. Asthma Controller Medication Adherence Report - Improved adherence to controller medications such as inhaled corticosteroids (ICS) is recognized as an important factor in reduced morbidity and mortality. The Asthma Controller Medication Adherence Report identifies adult patients with persistent asthma who were prescribed at least one controller medication and have a controller medication adherence rate of less than 75% in the defined treatment period. The adherence rate is defined by the proportion of days covered (PDC). The Asthma Controller Medication Adherence report is sent to PCPs on an annual basis and can help PCPs identify non-adherence to controller medications, overuse of reliever medications, medications prescribed by other practitioners, and coordinate care with a specialist, if needed. Rheumatoid Arthritis (RA) Adherence Report The efficacy of disease modifying anti-rheumatic drugs (DMARDs) for RA is well established, however, poor compliance may limit the effectiveness. Reported DMARD compliance ranges from 58% to 91%. Launched in September 2014, a rheumatoid arthritis (RA) adherence report is sent to PCPs to improve adherence to DMARDs. Vivitrol Registry - Launched in May 2015, a Vivitrol Registry is sent weekly to prescribers whose patients have been newly prescribed Vivitrol therapy in an effort to encourage behavioral health treatment. Research indicates that patients have better treatment outcomes when treatment is combined with behavioral therapies. The registry also provides resources for the physician to help with substance abuse treatment planning. Metabolic Monitoring for Children and Adolescents on Antipsychotics - Children on antipsychotics are prone to significant weight gain, which can lead to diabetes and other weight-related issues such as cardiovascular risks. Therefore, it is recommended to annually test cholesterol and blood glucose levels. Our biannual metabolic monitoring report, launched in June 2015, is sent to the child s PCP and specialist and alerts physicians to gaps in cholesterol and blood glucose testing. It also coordinates care amongst multiple practitioners. Contracts with Hospitals - Effective January 1, 2005, HPHC s standard hospital agreements were modified to explicitly obligate providers to comply with the patient safety provisions of The Leapfrog Group, a national coalition dedicated to improving patient safety, and the Joint Commission, a national hospital accrediting organization, stating The Hospital also agrees to comply with the applicable reporting requirements of the Joint Commission and The Leapfrog Group, including compliance with reporting deadlines. This is in addition to long-standing general language requiring hospitals to participate in and comply with quality initiatives focused on patient safety 2

3 In 2008, Harvard Pilgrim launched its network-wide hospital pay-for-performance (P4P) program. All new and renewing hospital contracts are eligible for P4P terms that include incentives for use of evidence-based guidelines and processes of care. The P4P contracts tie a portion of hospital payment to process of care and outcome scores reported on Hospital Compare. These measures are Medical Process of Care and Surgical Process of Care, Patient Safety and measures of patient satisfaction with the hospital experience. P4P contracting has been well accepted by the network as an important driver of hospital efforts to improve patient safety through adherence to guidelines and promotion of patient centered care processes, including effective communication, medication teaching and discharge instructions. Contracts with physician groups - In addition to hospital incentives, we offer pay for performance incentives to our entire physician network to implement safety measures. There are five (5) domains in our standard Quality Advance Program (QAP): Infrastructure support, Efficiency, HIT (Health Information Technology), Patient Experience and HEDIS clinical quality. Our network providers use electronic health records (EHRs) with functionality and decision support tools designed to address a variety of patient safety issues. To reward adoption, the QAP HIT domain rewards participation and performance on the CMS Meaningful Use Stage 1 measure set, and serves to support the network as it moves towards increased EHR functionality. E-prescribing, demonstrated to prevent prescribing and dispensing errors, is an example of a safety measure in the QAP MU domain. The Patient Experience Survey (CG-CAHPS) domain rewards performance on several composites tied to patient safety, such as ensuring access when needed, care integration and provider-patient communication. Several HEDIS measures included in the QAP clinical quality domain have patient safety benefits. For example, Appropriate Use of Antibiotics in Adults with Acute Bronchitis is designed to reduce inappropriate antibiotic prescribing. Medication Management for People with Asthma reduces the risk of asthma exacerbations for this population at risk. Leapfrog patient safety initiatives - As a licensed Leapfrog partner, HPHC regularly monitors the Leapfrog hospital safety and quality data downloads. The data is part of HPHC s hospital network evaluation for the annual Hospital Honor Roll and Hospital Quality Report program. Hospital Quality Reports and Honor Roll - Harvard Pilgrim evaluates all contracted acute care hospitals annually ( Hospital Quality Report ) and posts results on its provider and member web sites each November (harvardpilgrim.org/hosphonorroll). The evaluation includes the four process of care measures as reported on CMS Hospital Compare, HCAHPS patient experience results, CMS Outcome Measures (Healthcare Associated Infections/HAI and AHRQ PSI-90 safety composite) and four Leapfrog safety measures (Computerized Physician Order Entry, ICU Staffing, Safe Practices and Never Events). For each hospital, composite process of care scores are created using the opportunity method (dividing the sum of all the patients who received the recommended care by the 3

4 sum of all patients who should have received the appropriate care) for cardiac care, pneumonia care and surgical care preventing infections and complications. Harvard Pilgrim will post its ninth annual "Hospital Honor Roll" on its provider and member Web sites in January The Honor Roll recognizes adult acute care hospitals whose performance was among the top 25% of those measured nationally on a set of process of care composites, patient experience (HCAHPS), patient safety outcomes (HAI and AHRQ PSI-90 data) and Leapfrog patient safety measures. Quality Grants Program - HPHC s Quality Grants Program, initiated in 2000, provides funds through a grant process to physician groups for implementing selected quality and patient safety initiatives within their practices. The program s main objectives are to: Promote the development of quality improvement processes within and across practices by providing support to the leadership of the LCUs that are prepared to address quality and safety gaps; Through oversight of grant projects, identify best practices and share experience and contact information with HPHC network practices through the provider Web site, publications and at bi-annual Medical Director meetings. In April 2015, HPHC awarded grants totaling close to $1.5 million to Harvard Pilgrim providers in LCUs and other practitioner-based quality partnerships in Massachusetts, New Hampshire and Maine. The grants fund practice-based initiatives designed to improve care delivery and reduce costs within a variety of care deliver models. Details of project outcomes are posted on Harvard Pilgrim s provider Web site. Since its inception in 2000, the Harvard Pilgrim Quality Grants program has funded more than 200 initiatives, with over $17 million dollars in total support. Collaboration with external organizations - Several Health Services staff members participate in collaborative initiatives with external organizations that focus on improving quality and safety of patient care. HPHC participates in the Massachusetts Coalition for the Prevention of Medical Errors, a first-in-the-nation public-private partnership established in 1997 to improve patient safety and minimize medical errors. Harvard Pilgrim s involvement includes participation in the Coalition s monthly meetings and in all its health plan-related activities. HPHC s representative is the Medical Director for Network Medical Management. HPHC participates in the Massachusetts Health Quality Partners (MHQP), a coalition of physicians, hospitals, health plans, purchasers and government agencies established in Their current focus is to drive measurable improvements in health care quality, patient centered care or patient experience of care and effective use of resources through broad based collaboration among health care stakeholders and public engagement. HPHC s Chief Medical Officer (CMO) participates on the Statewide Quality Advisory Committee (SQAC), a Massachusetts governmental committee functioning in an advisory capacity to all branches of state government regarding the alignment of health care performance metrics and the efficient collection and 4

5 uniform reporting of the Standard Quality Measure Set in order to support improvement in the health status of the residents of Massachusetts. Harvard Pilgrim's CMO participates on the AHIP (America's Health Insurance Plans) CMO Leadership Council. This council is looked to nationally for the health plan perspective on a variety of issues including performance measurement, pay-for-performance programs, adoption of clinical IT, bioterror/disaster planning and more. For over 10 years, the CMO or his designee has been a member of the Massachusetts Medical Society s Committee on Quality of Medical Practice. HPHC s CMO serves on the Advisory Board of ICER (Institute for Clinical and Economic Review). HPHC s Chief of Innovation and Strategy serves on the Board of NEHI (New England Healthcare Institute). Member and practitioner education - HPHC develops and publishes educational articles for both member and practitioner newsletters and Web sites that address overall concepts of patient safety and medication error prevention, as well as providing specific information about its safety initiatives. Clinical Occurrence Reporting - HPHC has a process for identifying clinical incidents, including safety issues and medication errors, occurring to Harvard Pilgrim members in acute and extended care facilities via the completion and submission of clinical occurrence reports. Reports are completed by HPHC nurse case managers and are investigated by Harvard Pilgrim s Clinical Complaints or Credentialing staff. Clinical Complaints - Harvard Pilgrim investigates all safety issues reported by HPHC members, as part of the Member Complaints process. Trends related to clinical complaints and occurrence reporting are monitored by the Medical Management and Quality Committee. Complaints and occurrence reports are both used for quality profiling in the practitioner and facility recredentialing process. Credentialing - Harvard Pilgrim has a process for credentialing all practitioners by verifying that they have the appropriate education, training, and professional history, and by conducting peer review of adverse professional history issues. Additional safeguards include conducting site visits to any practitioners offices about which we have received facility-related complaints from HPHC members. The staff conducting a site visit will assess the validity of the complaint, issue a corrective action plan, if necessary, and monitor compliance with the plan, as needed. 5