Neighborhood is committed to assuring that its members receive care that is reliable, effective, consistent and safe. The following activities are undertaken as a demonstration of Neighborhood’s commitment to continuously improve clinical practices and ensure the safety of its members:

• Comprehensive site assessments during the credentialing and recredentialing process for those providers who meet the designated criteria to ensure that patient care sites meet Neighborhood’s standards for safety and cleanliness.
• Additional site visits for any complaint about site environment including those about safety, physical access, and cleanliness.
• Continuous monitoring of entire network’s licensing status and exclusion listings.
• Notification to the GAU and Quality Assurance Specialist of any potential quality or safety cases (e.g., significant provider errors including pharmaceutical errors, unexpected deaths, missed diagnoses or treatments, missed follow-up, or insufficient discharge planning).
• Investigation and tracking of quality of care complaints, identification of trends, institution of increased monitoring as appropriate.
• Monitoring of reportable events for long-term care facilities which include but not limited to falls, suspected abuse and/or neglect, medication errors, pressure ulcers, urinary tract infections, antipsychotic medication use, and/or preventable hospital admissions from the long-term care facilities.
• Monitoring of Provider-Preventable Conditions (“Never Events”) and Healthcare Acquired Conditions in inpatient facilities.
• Monitoring of critical incidents including but not limited to hospitalizations, suspected abuse, medication error resulting in ER visits and /or hospitalization, severe injury, theft against member and unexpected death.
• Committee review and consideration of new technology, new uses of existing technology, and new pharmaceuticals to ensure the safety, efficacy, and effectiveness of each.
• Enhanced Safety/Monitoring Solutions – members with high risk dispensing patterns (narcotic/narcotic combination drugs, anti-anxiety and sedative/hypnotic agents, non-benzodiazephine sedatives/hypnotics, muscle relaxation, central nervous system stimulants, anabolic steroids and all other controlled substances, gabapentin products).
• The ESMS program provides the framework for Neighborhood’s comprehensive opioid program which grants the plan the opportunity to lock in “at risk members” to a specific pharmacy or prescriber.
• Notification to patients and providers of medications recalled by the FDA and other risks related to pharmaceuticals.
• Drug Utilization Reviews targeting members and prescribers who meet specified criteria involving antipsychotic, narcotic and other medication classes.
• Care coordination discharge planning to ensure safe transitions, medication reconciliation, and follow up.
• Case and utilization managers have access to data across the continuum of care including inpatient, outpatient, and pharmacy. Care is also coordinated with onsite behavioral health clinicians.
• Care Coordination High Risk outreach programs for ER, readmissions, and poly-pharmacy.
• Targeted and general member educational outreach (Member Newsletters or telephonic outreach).