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The Foreign Service Benefit Plan, with assistance from our underwriter Mutual of Omaha and our Pharmacy Benefit Manager (PBM) Medco Health, is committed to setting standards that encourage best practices to 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

A. Disease Management Program

Mutual of Omaha's disease management program Healthydirections^sm for congestive heart failure, diabetes and asthma 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. Members enroll in the program voluntarily either directly or through Plan contact. All aspects of the patient's disease are coordinated in a team effort between the physician, the patient and the disease manager.

Medco Health designed their award-winning health management program, Positive Approaches™, to identify and reduce healthcare costs while improving the health and satisfaction of those members with chronic conditions. Positive Approaches™ focuses on those disease states and conditions (which include hepatitis C, multiple sclerosis and digestive health) that are associated with high overall healthcare expenditures and where pharmaceutical interventions have the most significant impact. The programs use a population-based, opt-out approach to reach patients most in need of education and self-management techniques and least likely to self-enroll. Members receive an on-going series of educational materials and behavioral interventions based on the specific needs of each disease state to enhance the patients' quality of life.

B. Centers of Excellence/Medical Specialty Network

Mutual of Omaha's medical specialty network consists of 14 centers of excellence. These centers are initially credentialed, recredentialed annually and are specifically contracted to provide transplant services to our members. 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.

C. Drug Utilization Review-Medco Health

Concurrent Drug Utilization sends alerts to pharmacists at the point of dispensing. An independent Pharmacy and Therapeutics Committee updates drug-drug interactions and ensures information accuracy. Medco Health screens prescriptions for a broad range of safety and economic considerations such as: severe drug interactions (possibly fatal), drug interactions (ineffective or unsafe), drug-allergy (in conflict with patient's reported allergies), drug-disease (may potentially worsen the patient's reported medical condition(s)), therapy duplication (several drugs in the same therapeutic class), excessive daily dosing and duration of therapy, drug-gender contraindications, refill-too-late (patients may be noncompliant with their drug therapy), refill-too-soon (prevents waste and exposure to potentially dangerous amounts of medication), potential drug name confusion, drug-age (drugs contraindicated for use by older adults or by children age 18 years or younger), drug-pregnancy, lethal dosing of chemotherapy and controlled substance alerts.

Medco Health's award-winning Partners for Healthy Aging® initiative, established in 1995, provides comprehensive information to older adults on safe and appropriate drug use. The program uses extensive geriatric expertise and the technology platforms necessary to help seniors avoid drug complications that can seriously affect their health.

Here are a few examples of how Partners for Healthy Aging® works for seniors:

• Drug Safety Checks. Medco Health automatically checks prescriptions through mail service pharmacies and participating retail pharmacies for proper dosage and potential drug interactions. Medco Health has over 200 safety checks geared specifically to the needs of older adults that are developed by an external advisory board with geriatric experts.

• Online Access to Healthcare Information. The Partners for Healthy Aging® section of Medco Health's web site at www.medcohealth.com provides information about the proper use of prescription drugs and other health-related articles relevant to older adults. Members can also access the content of Medco Health's Medication Guidebook for Older Adults, a comprehensive reference guide with easy-to-read medical information.

• Pharmacists and Customer Service Representatives Trained to Address Health Needs. Medco Health's pharmacists are available to answer member questions 24 hours a day. In addition, Medco Health's customer service representatives can answer questions related to specific prescription drug plans.

D. Credentialing

An integral part of developing or expanding a 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. 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 at least every two years, based on the date the provider was initially approved by the Credentialing Committee, and is ongoing and up-to-date. Subject to any relevant contractual provisions, a provider's participation status may be terminated if Mutual of Omaha becomes aware of any infractions of the required credentialing standards.

Mutual of Omaha 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.

E. Total Care Management (TCM)

Mutual of Omaha's Total Care Management (TCM) approach, led by their Professional Medical Management Team, combines a customer-centered strategy that focuses on high-quality medical care provided in the most appropriate setting, while managing costs. Their TCM programs include Utilization Management, Case Management, Healthy Pregnancy, Disease Management, Prescription Drug and Specialty Pharmacy Program, Medical Specialty Network and their National Ancillary Network. Mutual's Professional Medical Management Team is comprised of Board-certified Medical Directors supported by Board-certified medical physicians and other medical consultants, providing review expertise in specific specialty areas. Care Coordinators, who are registered nurses, and licensed mental health practitioners, help ensure effective coordination of specialized care for plan members. Doctors of Pharmacy (registered pharmacists) provide expertise in rational drug therapy and cost-effective use of medications in treating medical conditions. A key component to the success of Mutual's TCM program is full-system integration within Mutual of Omaha. This integration allows real-time data to be accessed by multiple areas within the company to provide for consistent communication.

F. Utilization/Medical Management Programs

The Mutual of Omaha Corporate Utilization Management (UM) Program is a formal process that evaluates necessity, appropriateness, efficiency, quality, and efficacy of medical services provided for members. Mutual of Omaha, through their website and upon request, has evidence based criteria available to physicians.

• Independent Accreditation Agencies and Other Associations

Mutual of Omaha is very dedicated in supporting efforts for affordable quality healthcare by eliminating redundancies and inefficiencies. Mutual of Omaha is an active participant in the Coalition of Affordable Quality Healthcare (CAQH). CAQH members, including Mutual of Omaha, are assessing the viability of making the benefit guide information available on-line. Mutual of Omaha Companies is committed to providing quality, cost-effective health care. This is supported by their full accreditation for Utilization Management from URAC (Utilization Review Accreditation Commission). Accreditation from URAC is an indication that a managed care organization has the necessary structures and processes to promote high quality care and preserve patient rights.

Goals and Outcomes of Patient Safety Initiatives

Through the above initiatives, and under the direction of Mutual of Omaha's Patient Safety Officer, Anthony Metcalfe, MD, Senior Vice President, Medical Management, and Medco Health's Patient Safety Officer, Dan Walden, Senior Vice President - Regulatory, Chief Privacy Officer, our goals are to increase member awareness and provide safety measures for their healthcare. Through our programs, we strive for a total care management approach for our members, which provides for consistent and coordinated care. These programs provide education to our members, which allows for a more informed consumer who can actively participate in their healthcare decisions. For more on-line information, please review Mutual's web site at www.mutualofomaha.com and Medco Health's web site at www.medcohealth.com.

Measurement of Patient Safety Initiatives

The Plan monitors the measurement of patient safety initiatives through Mutual of Omaha's and Medco Health's utilization reports, patient surveys and overall member activity. We continue to monitor and evaluate additional opportunities for patient safety and education.