U.S. Office of Personnel Management - Ensuring the Federal Government has an effective civilian workforce

Vantage Health Plan, Inc. (VHP) works to provide our members with, not only quality and affordable health care, but also a safe environment for that care. This begins even before you join VHP as an HMO member. All of our physicians are credentialed before they are added to our network. This means they have to be approved before becoming a participating provider. Part of this process requires that their medical office meet certain safety standards.

Once you become a Vantage member, we ask that you choose a primary care physician (PCP) for yourself and each dependent on your policy. This is done so you have one physician overseeing your total care; thus, preventing duplication of treatment, diagnostic testing and potential adverse drug interactions.

VHP provides pharmacy benefits through AdvancePCS, which allows drug utilization review at the very time your prescription is filled at the pharmacy. If the prescription you are getting has a possible adverse interaction with your current medications, the pharmacist will notify you and your physician so your physician can change that prescription before you take it.

The Vantage Medical Management Department is made up of registered nurses and physicians who review both inpatient and outpatient care before, during and after to decrease the chance of possible poor outcomes. This is called prospective, concurrent and retrospective review and is part of case management. The registered nurses use a national review standard called InterQual to be certain the level of care meets the severity of illness. Once all clinical information is reviewed, approval is automatically given for covered services if the standard is met. If the standard is not met, the registered nurse refers the case to a VHP medical director for review.

Vantage has a Utilization Review/Quality Management (UR/QM) Committee made up of in-network physicians of various specialties that meet monthly to analyze and review the care that was delivered the previous month. This allows VHP to make changes as needed to continually improve the quality of care.

Quarterly, VHP publishes a member and a provider newsletter. Each newsletter is written specifically for it's intended audience and provides information regarding how to make the Plan work more efficiently for you and your physician as well as safety tips for our members. Should you desire to talk to a Vantage representative personally, the newsletters also contain phone numbers and contacts for questions.

Vantage Health Plan, Inc. strives to be a health care innovator by proactively seeking opportunities to improve the quality of health care while balancing the cost of that care.

We are committed to service. We believe our employees, members, and providers deserve and expect honesty, integrity, quality, and excellence in an insurance company. We believe outstanding customer service is achieved by continually working to improve oneself and the health care product provided.

We are committed to strength. We're strong to keep you strong. We believe in providing our members with wellness and preventive services to promote health. We strive not only to offer quality health care, but a higher quality of life as a result of that health care.

We are committed to satisfaction. We believe communication must be clear to all for proper expectations to be met. Only with the understanding of one's coverage can proper expectations be made and satisfaction obtained. It is the goal and desire of every employee to provide excellent customer service thereby achieving member and provider satisfaction.

We are committed to solutions. We believe that for every challenge there is a win-win solution. We believe that a strong provider network and a variety of products are needed to meet the needs of our community and to provide quality health care.

We are committed to success! We believe that companies don't succeed, people do! You make Vantage Health Plan, Inc. possible. Therefore, it is our mission to help you succeed by providing exceptional service, rock-solid strength, customer satisfaction, and innovative solutions for your health care coverage needs.

Vantage Health Plan, Inc. is extremely pleased to be a participant in the Federal Employees Health Benefits Program. We look forward toward serving you in 2004.