Physicians Plus Insurance Corporation (Physicians Plus) is committed to ensuring that its members have access to high quality health care. Physicians Plus’ monitors quality measures in the following areas:
- Behavioral health services
- Patient safety
- Health promotion and disease prevention
- Acute and chronic care, including adherence to clinical practice guideline
- Continuity and coordination of care
- Under- and over-utilization of services
- Complaint and grievance data
- Return on Investment (ROI) analysis
- Satisfaction with disease management and complex case management programs
- Access and availability to health plan services, and medical and behavioral health care services
The following excerpt from Physicians Plus’ 2012 Quality Management Program description highlights Physicians Plus commitment to patient safety:
Patient Safety Monitors and Activities
Physicians Plus addresses patient safety in the following ways
- Identifying potential clinical care issues via concurrent review conducted by Physicians Plus’ registered nurses and through ongoing communications with discharge planners at network hospitals.
- Reviewing and responding to quality of care complaints and patient safety concerns in accordance with Physicians Plus established processes. Physicians Plus monitors for adverse events as stated in the Quality of Care Complaint process, the Concurrent Review of Inpatient Admissions Procedure, and the Quality of Care Concern policy. Established processes allow for identification, investigation, and evaluation as to the severity of the event. Issues determined to be severe in nature are forwarded to the Peer Review Committee.
- Providing follow-up with members through complex case management and disease management programs to ensure that care is received in a timely manner.
- Addressing opportunities for improvement in continuity and coordination of medical care, and between medical and behavioral health care.
- Monitoring new clinical sites for safety issues through facility review audits.
- Monitoring dosage and duration of prescribing habits for selected high-risk conditions via pharmacist reviews of members in case management.
- Collaborating with Argus (pharmacy claims processing vendor) to monitor member prescriptions for possible contraindications.
- Supporting Meriter Hospital’s patient safety activities via the annual Clinical Quality Incentive Program. Meriter Hospital’s areas of focus include:
- Reducing hospital acquired infections through educating, implementing and measuring compliance with care prevention bundles for Central Line-Associated Bloodstream Infections (CLABSI), Clostridium Difficile Infections (C difficile), Catheter Associated Urinary Tract Infections (CAUTI) and Ventilator Associated Pneumonia (VAP)
- Improving patient satisfaction with pain management
- Reducing medication errors involving electrolyte replacements, secondary IV infusions and IV pump use
- Improving risk-adjusted complication rates as reported through Thomson Reuters
- Maintaining risk-adjusted mortality rates as reported through Thomson Reuters