Federal Employees Health Benefits Program

Improving the Quality of Healthcare-2005 Foreign Service Benefit Plan

Foreign Service Benefit Plan, with assistance from underwriter Mutual of Omaha and our Pharmacy Benefit Manager, Medco Health Solutions, 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
   Our 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. For 2004 we are also adding disease management programs for COPD and coronary artery disease. The program manages a patient's symptoms in conjunction with his/her physician's treatment plan. Members enroll in the program voluntarily 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.

2. Centers of Excellence/Medical Specialty Network
   Our Medical Specialty Network has contracts with national providers for organ and tissue transplant procedures. These providers meet our 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, Data Management.

3. Concurrent Drug Utilization Review-Medco Health Solutions
   The following programs are in place to safeguard patients from potential harmful drug interactions, over utilization and other adverse drug events:

   • Edits that alert pharmacists to serious drug-drug interactions are continually updated. Examples of Drug safety alerts include:
     1. Excessive daily does
     2. Excessive duration
     3. Drug interactions
     4. Therapy duplications
     5. Gender contradiction
     6. Potential drug name confusion
     7. Refill too soon
   • 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.
   • Drugs without acceptable risk/benefit ratios are excluded from formulary inclusion.
   • In addition, we immediately notify members of drug recalls and work to make appropriate operational changes.

   Medco Health, serving over 40% of seniors age 65 and older nationwide, is a leader in providing prescription drug care to older adults and is committed to addressing their special needs. 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. Prescriptions through Medco Health's mail service pharmacies and participating retail pharmacies are automatically checked 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. You 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 your questions 24 hours a day. In addition, Medco Health's customer service representatives can answer questions related to specific prescription drug plans.

4. 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 shall be 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.

5. Total Care Management(TCM)
   

Mutual of Omaha's Total Care Management (TCM) approach, led by our 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. Our TCM programs include Utilization Management, Case Management, Healthy Pregnancy, Disease Management, Medical Specialty Network and our National Ancillary Network. Our 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 our TCM program is full-system integration within Mutual of Omaha. This integration allows for real-time data to be accessed by multiple areas within the company to provide for consistent communication.

6. 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 insureds and their dependents. Mutual of Omaha, through their website and upon request has available to physicians, evidence based criteria.

7. Independent Accreditation Agencies and Other Associations
   

Mutual of Omaha is very dedicated in supporting efforts to assist in 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 and this is supported by our 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, M.D., Senior Vice President, Medical Management, 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
Measurement of these activities is monitored through our utilization reports, patient surveys and overall member activity. We continue to monitor and evaluate additional opportunities for patient safety and education.