Health plan patient safety initiatives (10 July 2024)

Summary

When we think of improving patient safety, we often think of strategies that can be implemented at the healthcare organisation or healthcare professional level. However, improving patient safety is a multifaceted issue, and health plans play an important role in monitoring and improving patient safety.

In the United States, insurance status can determine a patient’s access to safe, high-quality health care. The Patient Protection and Affordable Care Act (ACA), established in 2010, sought to improve access to care by expanding coverage through Medicaid and reforming the private insurance market. The ACA specifically sought to improve patient safety by establishing quality reporting programs and pay-for-performance initiatives that tied reimbursement payments to quality measures and patient safety indicators. It also mandated funding for patient safety initiatives and research and highlighted the role of health plans as critical players in patient safety.

Health plans have a unique position in addressing patient safety, as their covered services can impact patient access to care. Although there is extensive published literature on the health plan’s role in monitoring and improving healthcare quality, a limited body of work specifically examines the health plan’s role in monitoring and improving patient safety. However, health care quality and patient safety are closely intertwined, and patient safety events often overlap with quality issues. This essay published on PS Net explores ways that health plans are currently monitoring patient safety and discusses opportunities and initiatives at the health plan level to improve patient safety.