+-----------------------------------------+----------------------------+
| ### FEHB Program Carrier Letter         | **U.S. Office of Personnel |
|                                         | Management**               |
| **All Carriers**                        |                            |
|                                         | #### Of                    |
|                                         | fice of Insurance Programs |
+-----------------------------------------+----------------------------+
| **Letter No. 2000-02** **Date:**        |                            |
|                                         |                            |
| Fee-for-service \[ 02\]                 |                            |
| Experience-rated HMO \[ 02\]            |                            |
| Community-rated \[ 02\]                 |                            |
+-----------------------------------------+----------------------------+

**SUBJECT:** **Family Centered Activities by FEHB Health Carriers**

The Office of Personnel Management (OPM) has encouraged health carriers
participating in the Federal Employees Health Benefits (FEHB) Program to
expand their "Family Centered Health Care Initiatives." This was spurred
by the Vice President's 7^th^ Annual Family Reunion, which focused on
families and health, as well as our belief that family centered care is
both effective and efficient. Earlier in 1999 we asked participating
carriers to tell us about positive activities they are undertaking. This
letter summarizes what was reported and it provides a source of possible
activities carriers could adopt.

The main activities employed by FEHB carriers, some of which were
underscored by the Patient's Bill of Rights, include the following:

-   Coverage of childhood immunizations as provided in the American
    Academy of Pediatrics' guidelines;

-   Expanded coverage of cancer screenings;

-   Relaxed referral requirements to allow more access to a specialist
    without return visits to a primary care doctor for another referral;

-   Waived copayments for maternity care; and

-   Enhanced efforts to educate members about disease prevention and
    control.

Other carrier activities are listed in the enclosure to this letter. We
encourage you to build upon your efforts to expand your family centered
health care practices. The expansion of family centered activities by
our participating carriers is important. The family has significant
influence over an individual's health and well being. Because of this
influence, families must be respected and supported in their roles as
care givers and decision-makers. Please use the enclosure as a resource
in building upon your family centered care activities.

We encourage FEHB carriers to tell us more. Please call Mr. Eric Figg at
202/606-0745 or email to <edfigg@opm.gov>.

Sincerely,

> *(signed)*

Frank D. Titus

Assistant Director

For Insurance Programs

Enclosure

## Family-Centered Activities

## 

## *Family-centered activities are an important way to better serve FEHB enrollees. When developing or enhancing the services you provide, consider the following activities reported by other FEHB Carriers.*

## Prevention

-   Chronically ill members may select a specialist as their primary
    care doctor.

-   A diabetes program identifies members, through claims processing and
    referrals from case managers, to receive educational materials and
    diabetic supplies. One carrier reported monitoring lab results to
    assist in this identification process.

-   A breast cancer prevention program where the carrier sends cards to
    remind members to get an exam. The carrier also issues
    self-administered breast exam instruction cards to hang in the
    shower. The carrier's newsletter prints reminders on the importance
    of preventive services.

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-   Carriers mail periodic reminders urging members to get preventive
    health services. Examples include reminders to newborns and one year
    old children listing the immunizations that are due; reminders to
    women emphasizing OB/GYN physicals and mammograms (when age
    appropriate); and reminders to men to emphasize prostate screenings
    and other male related issues.

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-   Carriers reported sponsoring community events and programs to
    promote physical fitness, such as a junior tennis challenge, soccer
    games, health runs, and a wellness festival.

-   One carrier reported providing the spouses of pregnant members with
    a beeper during the last weeks of pregnancy.

-   One carrier reported the development of a test designed to give
    employees of a company the opportunity to receive feedback on how
    lifestyle impacts their overall health outlook.

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-   A 24-hour health information telephone line for use by plan members.

-   A Healthy Babies program was reported that provides guidance and
    support to women from pre-pregnancy through post-partum care. This
    program is designed to promote better maternity care, reduce the
    number of premature births and educate expectant parents. At times
    there are "give-aways" that might include some of the following:

1.  A book called "From Here to Maternity";

2.  A "Mother's Calendar" that gives helpful advice to the pregnant
    mother;

3.  A subscription to "American Baby" magazine; and

4.  A free baby monitor upon completion of an educational program.

-   One carrier reported a high-risk elderly case management program
    where enrollees age 65 and over complete an evaluation. The plan
    then determines a patient-specific risk factor. Patient's deemed as
    "high-risk" are referred to a family practice team. This team
    provides follow-up care that is specific to the patient's assessment
    results.

## Disease Management

-   Many carriers reported the use of case management to coordinate the
    relationships between members, providers and the carrier, or to
    track the medical services given to chronically ill members. One
    carrier defined case management as "developing a plan of care for
    the individual member including goals and educating the care
    management system on strategies to work with the individual."

-   Carriers reported programs for disease control, most commonly for
    asthma and diabetes. Family members may share in the education of
    disease control.

> Goals for one carrier's asthma program include:

1.  Appropriate utilization of medications; increase the number of
    moderate and severe persistent asthmatics who use the appropriate
    combination of short or long acting B2 agonists and inhaled
    corticosteroids;

2.  Increase the number of members who have home peak flow meters;

3.  Increase the number of members who know how to utilize a peak flow
    meter;

4.  Reduce the need for hospital and emergency room utilization and
    their associated costs;

5.  Improve the quality of life for asthma patients by increasing their
    control over the prevention and management of asthma exacerbations;
    and

6.  Educate patients to develop a partnership with their provider in the
    management of their asthma.

For asthma, another carrier provides the following free of charge:

1.  Actual classroom training,

2.  Peak flow meters,

3.  Home visits by asthma trained home call nurses,

### Quality of life surveys/assessments to decrease acute attacks and reduce severity levels,

4.  Organized activities sponsored by the American Lung Association,

5.  Toll free phone lines for prerecorded asthma information and nurses
    answering asthma related questions, and

6.  Case management for members with severe symptoms.

A diabetes program attempts to achieve intensive control by monitoring
blood sugars and HgbA1C, frequent insulin injections or insulin pump, so
diabetic members will experience a decrease in the rate of complications
directly related to abnormalities in the blood sugar. Other outcomes
expected include:

1.  Reduction in hospitalizations;

2.  Reductions in emergency room visits;

3.  Maintenance or improvement of member's quality of life;

4.  Increased member knowledge of their disease;

5.  Effective utilization of resources, both medical and financial; and

6.  Appropriate primary care response to problems identified by the
    member.

-   One plan reports its "Chronic Care Project" incorporates a team
    approach that uses population-based health assessments, risk
    stratification, and proactive outreach to deliver patient and family
    centered care.

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-   One carrier reported that using case management, some
    hospitalizations have been shortened and home convalescence has been
    possible because of close communication between the carrier, home
    health nurses, patients, and family caregivers.

-   A fee-for-service carrier reported its disease management vendor
    acts as a liaison to make sure patients get appropriate care and
    follow their care plan. The vendor works with the health plan to
    make sure essential, health maintaining services are accessible to
    the patient.

-   One carrier reported a program of provider-level drug utilization
    reporting, allowing the health plan and participating providers to
    more effectively manage prescribing patterns, including cost and
    abuse potential factors.

-   A smoking cessation program that identifies which stage of the
    quitting process the smoker is in, then offers different ways to
    quit smoking: "cold turkey," gradual reduction in the number of
    cigarettes smoked, or nicotine replacement therapy. A personal "quit
    guide" provides feedback tailored to the smoker's needs. There is a
    toll-free phone number for counseling and support.

-   A hypertension management program works with the carrier's doctors
    to develop and coordinate (via teleconference) guidelines on
    treating this disease.

-   A depression program that is a cooperative effort between one
    carrier and a vendor that provides the following:

1.  Work site education,

2.  Mailing of materials,

3.  Provider education, and

4.  Specialized case management.

-   A back and neck pain program where the carrier coordinates a medical
    team approach with each patient to provide aggressive pain
    management.

-   One carrier reported a "transplanting Health" program to assist
    eligible members who require a blood component, such as a bone
    marrow or organ transplant, in an effort to make receiving a
    transplant less difficult. The program promotes continuity of care
    through ongoing education, monitoring and early identification of
    potential problems by nursing professionals.

## 

## Member Education

-   Carriers have quarterly new member meetings to share information
    about disease control.

-   A "Timely Tots and Pregnancy Education" program where mothers-to-be
    get pregnancy risk assessment to decrease premature deliveries.
    Maternity nurses develop an obstetrical profile. Health problems are
    screened. Member's questions are answered. There is follow-up
    education and mailings. The carrier operates a 24-hour hotline. Case
    managers work with the doctors of expectant mothers who do not
    sign-up for the program.

-   Educational services are a key part of carrier's efforts to extend
    family centered health care to members. Education activities for all
    members include:

1.  Newsletters with articles focusing on health education, and
    reminders to get timely immunizations and preventive screenings,

2.  Specific educational pamphlets are included in packets to new
    mothers, displayed in the carrier's primary care doctor's offices,
    or mailed upon request,

3.  Reminder phone calls for adolescent immunizations, and

4.  Targeted newsletters and focused mailings for certain high-risk
    members.

> One carrier reported producing a newsletter that contains general
> health information and guidance on how to navigate through the health
> plan, such as how to use Member Services, and examples of treatments
> that need a referral. The plan produces this newsletter three times a
> year.

-   Classroom education can be effective in assisting the family to be
    healthier. Specific topics reported by carriers include:

1.  Childbirth preparation,

2.  Adult CPR,

3.  Nutritional programs for seniors,

4.  Smoking cessation,

5.  Weight reduction, and

6.  Stress management.

-   One carrier reported that its participating doctors sponsor seminars
    about various diseases and diagnoses.

-   One carrier reported sponsoring a series of 30-second radio
    announcements called "An Apple A Day" to educate the general public
    about health awareness and prevention.

## Other

-   One carrier reported coverage of inpatient hospital stays for a
    patient in a home hospice situation to provide a respite for family
    members.

-   A few carriers reported coverage of travel expenses for family
    members of a patient receiving a bone marrow transplant in a
    clinical trial.

-   Some carriers provide health club discounts.

-   Most carriers rely on their doctors to keep track of member's
    medical conditions. A few are more proactive and monitor patient
    care themselves, take steps to encourage members to obtain certain
    care, coordinate care with the doctors, and attempt to educate the
    family as well as the patient. One HMO reported employing a disease
    management vendor. The vendor acts as a liaison to make sure the
    patient gets appropriate care, remains compliant with their care
    plan and works with the carrier to make sure essential, health
    maintaining services are accessible to the patient (sometime
    accomplished through extra contractual benefits). A fee-for-service
    carrier reported employing a managed care vendor to train the
    carrier's customer service personnel to look for signs that a member
    is in need of social services and then to refer the member to
    agencies that provide those services.