Healthcare Plan Information

Improving the Quality of Healthcare- Foreign Service Benefit Plan

The Foreign Service Benefit Plan (FSBP), with assistance from our underwriter Coventry Health Care, Inc. and our Pharmacy Benefit Manager, Express Scripts (ESI)-Medco is committed to setting standards that encourage best practices and promote and increase patient safety, the reduction of medical errors and ongoing opportunities for member education. We pledge to assist OPM in providing Plan members with information and education regarding patient safety.

Current Patient Safety Initiatives and Expected Outcomes

1. Disease Management Program
   The FSBP's disease management program for congestive heart failure (CHF), diabetes, asthma, chronic obstructive pulmonary disease (COPD), coronary artery disease (CAD) and chronic kidney disease (CKD) seeks to improve patient outcomes and includes disease and patient monitoring, follow-up, and education. The program manages a patient's symptoms in conjunction with his/her physician's treatment plan. The Plan has an exclusive disease management program for members overseas. Members are automatically enrolled in the program. All aspects of the patient's disease are coordinated in a team effort between the physician, the patient, and the disease manager.

2. Centers of Excellence/Medical Specialty Network
   Optum's medical specialty network has contracts with national providers for organ and tissue transplant procedures. These providers meet standards for excellence in the services they provide and the outcomes they achieve. These transplant centers have demonstrated greater-than-average outcomes and less-than-average complication rates and are selected using a strict list of criteria including, but not limited to: Provider Transplant Program, Transplant Team, Facility, Patient Outcomes, Quality Assurance Programs and Data Management.

3. Drug Utilization Review-Medco
   The following programs are in place to address drug safety:

   • Edits that alert pharmacists to serious drug-drug interactions are continually updated.
   • New drugs are proactively marked if the possibility of interaction exists.
   • An independent Pharmacy and Therapeutics Committee updates drug-drug interactions and ensures information accuracy.
   • In addition, we immediately notify members of drug recalls and work to make appropriate operational changes.
   • RationalMed merges FSBP medical and prescription claims data. This program analyzes a patient's drug history to identify possible problems with drug interactions, dosages and duration of treatment and identifies patients at a high risk for drug-induced hospitalization. The program sends alerts to the patient's physician and provides data on personal prescribing habits, peer prescribing statistics, and current standards for care.

4. Specialized Care that Improves Safety, Effectiveness, and Affordability
   Express Scripts' Specialist Pharmacist care model delivers safer, more effective and more affordable pharmacy care. Through personalized care delivered by experienced Specialist Pharmacists within 15 Therapeutic Resource Centers, Express Scripts improves patient safety, adherence with essential medications, and affordability of drug regimens, closing important gaps in care, and optimizing therapies for members with chronic conditions.

   Members can benefit from the expertise of a Specialist Pharmacist at any time by calling toll-free and asking to speak with a Specialist Pharmacist. Members have access to Specialist Pharmacists, regardless of whether they fill their prescriptions through a retail pharmacy or through mail service. When members at high risk for a gap in care call Express Scripts, they have the opportunity to speak with a Specialist Pharmacist. For those highest risk members managing complex conditions, Specialist Pharmacists may reach out to the member or their physician through an outbound call to address important gaps in care.

5. Credentialing
   An integral part of developing or expanding Coventry's managed care organization is the selection of participating providers. The ability of an organization to attract those physicians who will render quality medical care and will share in the overall objectives of the organization is a principal factor in the success of that organization. Coventry credentials network providers to NCQA, URAC or state standards whichever is the highest for the products the provider is enrolled in.

   Credentialing plays a major role in the provider selection process. The information collected about each applicant and the standards used to evaluate this information significantly contribute to the selection of medical practitioners capable of providing quality medical care. Consistent use of the same information, requirements and standards affords the best opportunity for developing quality provider networks.

   The recredentialing process is conducted every three years, based on the date the provider was initially approved by the Credentialing Committee, or more frequently if quality problems or complaints arise.

   Coventry will verify that each of the health delivery organizations and institutions with which it contracts, i.e., hospitals, skilled nursing facilities, home health care agencies, free-standing surgical centers, and others, has met the required credentialing standards.

6. Health and Wellness
   The Plan offers a broad array of benefits and services to support members' healthcare needs. Through collaboration among our clinical professionals, members and health care providers, we promote the appropriate use of health care resources so that services are screened for the most appropriate, safe and cost-effective setting while supporting members with chronic or complex medical conditions. We manage the full spectrum of our members by taking a proactive approach to produce the best clinical and financial outcomes. We guide our Plan members into the appropriate service as necessary and provide health and wellness tools to help them become better consumers of health care. These services complement the Plan with an integrated wellness focus:

   • Utilization Management - ensures only necessary medical services are provided and reimbursed;
   • Behavioral Health Services - reviews mental health/substance abuse services to determine if they are necessary and appropriate and also manages Plan benefits for these services;
   • Disease Management Program - offers a collaborative approach of prevention, education and ongoing support between the Plan member, physician and case managers for members with certain chronic conditions;
   • Healthy Pregnancy Program - promotes healthy pregnancies through education and coordination of specialized care;
   • Medical Specialty Network - provides access to a nationwide network of organ and soft-tissue transplant medical centers that are recognized as "Centers of Excellence";
   • The Plan's provider network - delivers seamless care through a team of independent ancillary providers, including home health care, durable medical equipment, home infusion therapy, hospice, medical supply and orthotics/prosthetics services; and
   • Case management - assures that better outcomes for Plan members with conditions that lead to extended, highly specialized or resource-intensive care, can effectively manage member benefits and medical care. Members are referred to our Case Management program based upon an identification process by our utilization management, claims and customer service areas and predictive modeling system. Our case management program navigates members through the continuum of care, facilitates an appropriate use of Plan benefits, minimizes a member's out-of-pocket costs, and ensures better compliance with treatment. The end result is reduced claim costs by managing care in the appropriate setting, integrating our services and education our members on how to manage their illness and maintain a healthy lifestyle.

7. Utilization/Medical Management Programs
   The Plan is committed to providing quality, cost-effective health care and this is supported by Coventry's full accreditation for Utilization Management, Disease Management and Case Management from URAC, a nationally recognized accreditation agency. Accreditation from URAC is an indication that an organization has the necessary structures and processes to promote high quality care and preserve patient rights.

   Express Scripts has full accreditation for its mail order pharmacy network through JCAHO. The recognition applies to all services offered by Medco through its entire network of mail-order pharmacies. Express Script's pharmaceutical management programs meet all applicable National Committee for Quality Assurance ("NCQA") standards, as well as any applicable federal or state laws and regulations.

Goals and Outcomes of Patient Safety Initiatives

Through our wellness programs, our goals are to increase member education and implement safety measures to improve outcomes. The provision of education to our members allows for a more informed consumer who can actively participate in their healthcare decisions. The Plan helps insure quality care by reporting any potential safety concerns such as complications or adverse events identified through the utilization processes to the Quality Improvement staff for investigation and action as necessary.

Measurement of Patient Safety Initiatives

Measurement of these activities are monitored by the Quality Improvement Committee. Various reports are used for monitoring purposes, such as cost and utilization reports, patient surveys and overall member activity. In addition, quality improvement projects are undertaken and results reported to the committee on a quarterly basis.

We continue to monitor and evaluate additional opportunities for patient safety and education.

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