PREFERREDONE COMMUNITY HEALTH PLAN
6105 GOLDEN HILLS DRIVE, GOLDEN VALLEY, MN 55416 www.preferredone.com

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Organizations Filed Purposes: THE MISSION OF PREFERREDONE COMMUNITY HEALTH PLAN (PCHP) IS TO MAKE AVAILABLE TO THE RESIDENTS OF THE STATE OF MINNESOTA COMPREHENSIVE HEALTH MAINTENANCE SERVICES THAT ARE ACCESSIBLE, ACCEPTABLE, AND DELIVERED IN A MANNER CONGRUENT WITH THE ECONOMIC AND SOCIAL NEEDS OF THE COMMUNITY. THE HEALTH PLAN WILL ADVOCATE FOR IMPROVEMENTS IN THE DELIVERY, QUALITY AND COVERAGE OF HEALTH CARE SERVICES AND PURSUE HEALTH CARE PROGRAMS TO MEET COMMUNITY NEEDS.

PREFERREDONE COMMUNITY HEALTH PLAN MISSION THE MISSION OF THE QUALITY MANAGEMENT (QM) PROGRAM IS TO IDENTIFY AND ACT ON OPPORTUNITIES THAT IMPROVE THE QUALITY, SAFETY, VALUE OF CARE, AND SERVICE PROVIDED TO ALL PREFERREDONE MEMBERS, WORKING BOTH INDEPENDENTLY AND COLLABORATIVELY WITH CONTRACTED PRACTITIONERS AND COMMUNITY EFFORTS. AS PART OF THE ORGANIZATION'S MISSION, PREFERREDONE ADVOCATES FOR IMPROVEMENTS IN THE DELIVERY, QUALITY, AND COVERAGE OF HEALTH CARE SERVICES, AND PURSUES HEALTH CARE PROGRAMS TO MEET COMMUNITY NEEDS. IN 2018, PREFERREDONE COMMUNITY HEALTH PLAN MAINTAINED AN ACCREDITATION STATUS OF COMMENDABLE FROM THE NATIONAL COMMITTEE FOR QUALITY ASSURANCE (NCQA), A PRIVATE, NONPROFIT ORGANIZATION THAT EVALUATES AND REPORTS ON HEALTH CARE QUALITY. NCQA ACCREDITATION RECOGNIZES THE COMMITMENT OF OUR ORGANIZATION TO PROVIDE QUALITY HEALTH CARE TO OUR MEMBERS AND DEMONSTRATES THAT WE HAVE INCORPORATED QUALITY IMPROVEMENT INTO THE FABRIC OF OUR BUSINESS. OUR ACCREDITATION STATUS WAS AWARDED AFTER RIGOROUS EVALUATION BY NCQA OF ALL ASPECTS OF OUR PLAN, INCLUDING PREVENTIVE HEALTH SERVICES, MEMBER SATISFACTION, PHYSICIAN CREDENTIALING AND QUALITY IMPROVEMENT. PARTICIPATION IN COLLABORATIVE AND COMMUNITY PROJECTS IN AN EFFORT TO POOL RESOURCES, CREATE CONSISTENCY AMONG PROVIDER NETWORKS IN OUR COMMUNITY AND IMPROVE THE DELIVERY OF HEALTH CARE TO OUR MEMBERS PREFERREDONE PARTICIPATES IN SEVERAL COLLABORATIVE ACTIVITIES. MINNESOTA COMMUNITY MEASUREMENT (MNCM) IS A COLLABORATION AMONG HEALTH PLANS AND PROVIDER GROUPS WHOSE MISSION IS TO ACCELERATE THE IMPROVEMENT OF HEALTH BY PUBLICLY REPORTING HEALTH CARE INFORMATION. THE VISION OF MN COMMUNITY MEASUREMENT IS: -BE THE PRIMARY TRUSTED SOURCE FOR HEALTH DATA SHARING AND MEASUREMENT -DRIVE CHANGE THAT IMPROVES HEALTH, PATIENT EXPERIENCE, COST AND EQUITY OF CARE FOR EVERYONE IN OUR COMMUNITY -BE A RESOURCE USED BY PROVIDERS AND PATIENTS TO IMPROVE CARE -PARTNER WITH OTHERS TO USE OUR INFORMATION TO CATALYZE SIGNIFICANT IMPROVEMENTS IN HEALTH PREFERREDONE IS ONE OF SEVEN HEALTH PLAN FOUNDING MEMBERS OF MNCM. THE STATE MEDICAL ASSOCIATION, STATE HOSPITAL ASSOCIATION, PARTICIPATING MEDICAL GROUPS, CONSUMERS, BUSINESSES, HEALTH PLANS, AND STATE HEALTH AGENCIES ARE ALL REPRESENTED ON THE ORGANIZATION'S BOARD OF DIRECTORS IN EITHER A VOTING OR NON-VOTING CAPACITY. DATA IS SUPPLIED BY PARTICIPATING HEALTH PLANS ON AN ANNUAL BASIS FOR USE IN DEVELOPING THEIR ANNUAL HEALTH CARE QUALITY REPORT. MINNESOTA COUNCIL OF HEALTH PLANS (MCHP) IS A NON-PROFIT TRADE ASSOCIATION REPRESENTING MINNESOTA'S NON-PROFIT HEALTH PLAN ORGANIZATIONS. THE COUNCIL PROMOTES ACCESS TO HIGH-QUALITY, AFFORDABLE HEALTH CARE. HEALTH PLAN MEMBERS ARE ACTIVE IN THE AREAS OF HEALTH CARE REFORM, RESEARCH-BASED GUIDELINE DEVELOPMENT, COMMUNITY HEALTH AND PREVENTION, MEDICAL TECHNOLOGY ASSESSMENT AND HEALTH CARE QUALITY DATA COLLECTION. PREFERREDONE EXECUTIVES AND STAFF MEMBERS SERVE ON VARIOUS COMMITTEES THROUGH THE MCHP INCLUDING THE BOARD OF DIRECTORS, COMMUNITY HEALTH, COMMUNICATIONS, HEALTH POLICY, QUALITY AND MEDICAL ISSUES. ORGANIZATIONAL SUPPORT FOR EMPLOYEE VOLUNTEER EVENTS PREFERREDONE SUPPORTS COMMUNITY INVOLVEMENT THROUGHOUT THE ORGANIZATION. EVENTS ARE EMPLOYEE-DRIVEN, WITH THE ORGANIZATION ENABLING OR PROVIDING EMPLOYEE TIME AND/OR FINANCIAL SUPPORT TO ENCOURAGE VOLUNTEERISM. EXAMPLES INCLUDE: -UNITED WAY, COMMUNITY HEALTH CHARITIES & FAIRVIEW FOUNDATION -ON-SITE BLOOD DRIVES -SECOND HARVEST HEARTLAND OTHER CONDITION-SPECIFIC EDUCATION AND SUPPORT PROGRAMS COMPLEX CASE MANAGEMENT COMPLEX CASE MANAGEMENT IS THE COORDINATION OF CARE AND SERVICES PROVIDED TO MEMBERS WHO HAVE EXPERIENCED A CRITICAL EVENT OR DIAGNOSIS THAT REQUIRES THE EXTENSIVE USE OF RESOURCES AND WHO NEED HELP NAVIGATING THE SYSTEM TO FACILITATE APPROPRIATE DELIVERY OF CARE AND SERVICES. THE GOAL OF COMPLEX CASE MANAGEMENT IS TO HELP MEMBERS REGAIN OPTIMUM HEALTH OR IMPROVED FUNCTIONAL CAPABILITY, IN THE RIGHT SETTING AND IN A COST-EFFECTIVE MANNER. IT INVOLVES COMPREHENSIVE ASSESSMENT OF THE MEMBER'S CONDITION; DETERMINATION OF AVAILABLE BENEFITS AND RESOURCES; AND DEVELOPMENT AND IMPLEMENTATION OF A CASE MANAGEMENT PLAN WITH PERFORMANCE GOALS, MONITORING AND FOLLOW UP. IN 2018 THE COMPLEX CASE MANAGEMENT PROGRAM IDENTIFIED 6,109 MEMBERS WHO COULD BENEFIT FROM CASE MANAGEMENT SERVICES. THE CONDITIONS THEY TRIGGERED FOR ARE AS FOLLOWS: GENERAL MEDICINE28% POST ACUTE 61% ACUTE 6% CANCER 5% CHRONIC ILLNESS MANAGEMENT PREFERREDONE'S CHRONIC ILLNESS MANAGEMENT PROGRAM IS AVAILABLE TO MEMBERS WHO ARE DIAGNOSED WITH ANY OF THE FOLLOWING CHRONIC CONDITIONS: -DIABETES -CORONARY HEART DISEASE -CONGESTIVE HEART FAILURE -CHRONIC OBSTRUCTIVE PULMONARY DISEASE -ASTHMA (ADULT AND JUVENILE) -RARE CONDITIONS (ULCERATIVE COLITIS, CROHN'S DISEASE, RHEUMATOID ARTHRITIS, MULTIPLE SCLEROSIS, SICKLE CELL, CYSTIC FIBROSIS, LUPUS, PARKINSONS, MYASTHENIA GRAVIS, HEMOPHILIA, SCLERODERMA, DERMATOMYOSITIS, MYOSITIS, POLYMYOSITIS, CIDP, ALS, AND GAUCHER DISEASE) THE GOALS OF THE CHRONIC ILLNESS MANAGEMENT PROGRAM ARE TO PROMOTE SELF- MANAGEMENT OF CHRONIC CONDITIONS, IMPROVE ADHERENCE TO TREATMENT PLANS WITH AN EMPHASIS ON MEDICATION THERAPY, REDUCE OR DELAY DISEASE PROGRESSION AND COMPLICATIONS, REDUCE HOSPITALIZATIONS AND EMERGENCY ROOM VISITS AND IMPROVE QUALITY OF LIFE. IN 2018 THE CHRONIC ILLNESS MANAGEMENT PROGRAM IDENTIFIED 6,988 MEMBERS WHO COULD BENEFIT FROM DISEASE MANAGEMENT SERVICES. THE CONDITIONS THEY TRIGGERED FOR ARE AS FOLLOWS: DIABETES 61% ASTHMA 20% CAD 9% CHF 5% COPD 5% QUIT FOR LIFE PREFERREDONE CONTRACTS WITH OPTUM FOR ITS QUIT FOR LIFE TOBACCO CESSATION PROGRAMMING (FORMERLY ALERE/FREE & CLEAR). THIS PROGRAM USES INBOUND AND OUTBOUND TELEPHONE SUPPORT TO SYSTEMATICALLY MOVE PARTICIPANTS TOWARD A SUCCESSFUL QUIT. THE CORE COMPONENTS OF THE QUIT FOR LIFE PROGRAM INCLUDE: -INDIVIDUALIZED TELEPHONIC COUNSELING WITH A TOBACCO CESSATION SPECIALIST -PRINTED SELF-PACED MATERIALS (THE QUIT KIT) -EVALUATION AND DOSING RECOMMENDATIONS FOR NICOTINE REPLACEMENT THERAPY OR ZYBAN -OPTIONAL DIRECT MAIL-ORDER DELIVERY OF NICOTINE REPLACEMENT THERAPY -UNLIMITED USE OF A TOLL-FREE INBOUND SUPPORT LINE QUIT FOR LIFE IS A SYSTEMATIC AND SOLID SCIENTIFIC EVIDENCE-BASED BEHAVIOR CHANGE PROGRAM THAT HELPS TOBACCO USERS QUIT. CLINICAL TRIAL RESULTS INDICATE THAT TELEPHONE COUNSELING, ALONG WITH SELF-HELP MATERIALS, INCREASES QUIT RATES. NATIONALLY TWELVE-MONTH QUIT RATES FOR THE PROGRAM IN 2017 WAS 27.0%. IN 2018, 74 PREFERREDONE MEMBERS ENROLLED IN THE QUIT FOR LIFE SMOKING CESSATION PROGRAM. HEALTH RISK ASSESSMENT (HRA) PREFERREDONE OFFERS A HRA THROUGH WELLSOURCE TO ALL PCHP, PIC, AND PAS MEMBERS AND THEIR DEPENDANTS. THE HRA IS ACCESSED ONLINE THROUGH THE PREFERREDONE MEMBER WEBSITE (WWW.PREFERREDONE.COM). THERE IS NO COST TO THE EMPLOYEE OR THEIR EMPLOYER FOR COMPLETING THE HRA UNLESS THE REPORTING AND HEALTH COACHING PACKAGE IS PURCHASED BY THE EMPLOYER GROUP. PREFERREDONE ENCOURAGES MEMBERS TO PRINT THEIR INDIVIDUAL RESULTS AND SHARE THEM WITH THEIR PHYSICIAN IF THEY DESIRE ADVICE OR DIRECTION TO IMPROVE THEIR LIFESTYLE. A TOTAL OF 1,267 PREFERREDONE MEMBERS COMPLETED THE HRA IN 2018. PATIENT SAFETY PREFERREDONE DEMONSTRATES A COMMITMENT TO PATIENT SAFETY BY INCORPORATING SAFETY INTO EXISTING QM ACTIVITIES AND TAKING PATIENT SAFETY INTO CONSIDERATION WHEN EXAMINING TRENDS AND DATA FOR POSSIBLE QUALITY IMPROVEMENT ACTIVITIES. PREFERREDONE ALWAYS IMPLEMENTS PROCESSES WITH OVERALL PATIENT CARE OUTCOMES AND SAFETY AS COMPONENTS OF QUALITY IMPROVEMENT ACTIVITIES. ELEMENTS OF PATIENT SAFETY ARE FOUND IN OUR EXISTING QUALITY IMPROVEMENT PROCESSES THAT INCLUDE, BUT ARE NOT LIMITED TO: -IDENTIFYING AND IMPLEMENTING PROCESSES FOR TRANSITIONS OF CARE FOR CONTINUITY AND SAFETY -IMPLEMENTING CARE MANAGEMENT PROGRAMS THAT INCLUDE FOLLOW-UP SYSTEMS TO ENSURE THAT CARE IS RECEIVED IN A RELIABLE AND TIMELY MANNER -IMPLEMENTING PHARMACEUTICAL MANAGEMENT PRACTICES AND POLICIES THAT INCLUDE SAFEGUARDS TO ENHANCE PATIENT SAFETY, INCLUDING AN EMERGING THERAPEUTIC ISSUES PROGRAM IN WHICH MEMBERS AND/OR PHYSICIANS ARE NOTIFIED OF SIGNIFICANT SAFETY ISSUES WITH PRODUCTS COVERED UNDER THE PHARMACY BENEFIT (INCLUDING PRESCRIPTION DRUGS AND CERTAIN MEDICAL DEVICES) -INCORPORATING ADVERSE EVENT REPORTING INTO THE CREDENTIALING PROCESS -TRACKING AND TRENDING ADVERSE EVENT REPORTING TO IDENTIFY SYSTEMS AND/OR NETWORK ISSUES THAT MAY COMPROMISE SAFETY -ANALYZING AND TAKING ACTION ON MEMBER AND PRACTITIONER COMPLAINTS AND SATISFACTION DATA THAT RELATE TO SAFETY -COLLECTING AND PROVIDING INFORMATION ON PROVIDER AND PRACTITIONER SAFETY AND QUALITY, INCLUDING ACTIVITIES ON PROVIDERS' ACTIONS TO IMPROVE PATIENT SAFETY AND TO MAKE PERFORMANCE DATA PUBLICLY AVAILABLE FOR MEMBERS AND PRACTITIONERS. CONTINUITY AND COORDINATION OF CARE PREFERREDONE DEVELOPS A WORK PLAN TO SPECIFICALLY ADDRESS ISSUES RELATED TO CONTINUITY AND COORDINATION OF CARE WITHIN OUR NETWORK FOR OUR MEMBERS. DATA FROM VARIOUS SOURCES AR

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