Member Safety Program in the Works

Patient safety is as critical in the examination room as in the surgical suite.

In 1999, the Institute of Medicine (IOM) report, To Err is Human, released surprising data showing that medical errors are the eighth leading cause of death in the United States. The IOM also reported that:

• Medical errors are grossly underreported because of legal concerns; therefore, the true extent of the problem is unknown.
• More people die each year from medical errors than from highway accidents, breast cancer or AIDS.
• Preventable health care-related injuries cost $17 billion to $29 billion annually — half in direct health care costs.

The report provided the impetus for cohesive patient safety programs by insurers, hospitals and government agencies.

For several years now, hospital care has gained oversight from the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Most patient care, however, is provided in an outpatient setting. According to the Agency for Healthcare Research and Quality (AHRQ), 217 people visit a physician office for every eight people hospitalized. More than half of these individuals are seen by a primary care physician.

“Most safety efforts still are focused on hospitals,” said Melanie Phillips, clinical advisor in Humana’s Quality Management Department, who is in the process of developing Humana’s Member Safety Program. “Hospitals have safety initiatives in place and oversight from JCAHO. We’re suggesting we can take steps to implement more safety awareness on the outpatient side.”

What is ‘safety’?
In a nutshell, patient safety can be defined as:

• Freedom from injury
• The absence of medical errors or adverse events

Safety also includes prevention of omissions in care, such as failure to provide preventive care or failure to follow up.

Resolving these issues is not easy. Yet Humana can offer physician practices tools for maintaining safety.

“Research has shown medical errors usually aren’t attributable to the actions of one individual, but tend to be the result of system errors,” Phillips said. “By offering tools to prevent some of those system errors, we at Humana can support physicians to keep members safer.”

The goal of Humana’s Member Safety Program is to improve member safety and decrease preventable health-related medical errors in the outpatient setting. While specifics are still in development, Phillips anticipates the program will focus on the following:

1. Medication safety:
   • Eliminating legibility issues through e-prescribing
   • Safe sampling in the physician office
   • Updated medication lists
   • Medication adherence
   • Reporting prescription filling and processing errors by pharmacies
2. Improved processing of labs, radiology and diagnostics by practitioner offices:
   • Implementing tracking systems for follow-up
   • Improving patient notification of test results
   • Ensuring signed reports
3. Identifying and improving continuity of care opportunities and recommending solutions to provider offices through coordination:
   • Between primary care physicians and specialists
   • Between care settings, such as hospitals and practitioner offices
   • Between behavioral health providers and PCPs
4. Investigating technologies that can improve safety:
   • E-prescribing
   • Electronic medical records
   • Personal health records

Humana’s goal is to develop and implement a member safety program that effectively delivers tools and services that may lead to improved clinical outcomes and avoidance of preventable adverse events.

Watch for more information about the Member Safety Program in 2007.

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