Federal Employees Health Benefits Program, Office of Personnel Management push idea of medical home

The Federal Employees Health Benefits Program (FEHBP) is moving its considerable influence behind the concept of the medical home. In its annual call in March for benefit and rate proposals from various health plans, FEHBP emphasized that it has a key interest in advancing coordinated care.

Christine Hunter, MD, chief medical officer of the US Office of Personnel Management (OPM), which oversees the FEHBP, says, "Right up front is the patient medical home as the nexus of care coordination."

The FEHBP is often looked to as a model for insurance coverage because it covers 8 million lives across the age spectrum and offers choices of 91 health plans.

"We hope that we will be leaders in specifying what employers want on behalf of their employees with respect to the patient-centered medical home," she said.

Each insurance plan that operates under the program will have to report the percentage of practices in their network that have achieved medical home status. "And we want to see that number go up," said Hunter.

The OPM will also ask the plans to report the number of their patients who are enrolled in medical homes, as well as the plans' criteria for recognizing a practice as a medical home, such as the standards available through the National Committee for Quality Assurance, URAC, and the Joint Commission.

"Then we want the plan to give us a breakdown of which provider payment incentives have they found most useful. We understand that one needs to pay differently for this care. And we want to include it in our premium negotiations," Hunter stated at the meeting.

The OPM also wants to know how the plans are marketing medical homes, she said. So it will ask how the plans are going to do outreach to tell members there is an opportunity to do things better or that there are new services to help the employees and their families stay healthy.

Hunter wants to ask, "How are patients going to be informed of the quality outcomes that are associated with a patient-centered medical home?" She cited Web sites, provider directories, patient newsletters, secure email messaging, or text messaging as possible avenues.

The OPM wants to support other medical home pilots initiated by different segments of the federal government and state governments, she said, pointing to efforts such as work on various aspects of care coordination and fitting medical homes into accountable care organizations.

If carriers can bring their federal employee population in addition to their Medicare or Medicaid populations to one of these pilots, they are invited to propose that to OPM, Hunter said at the meeting.

In its recent guidance letter, the OPM, which covers 2,800 births a week, told carriers about its special focus on maternity and neonatal care. Pointing to guidelines from the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics that seek to eliminate elective delivery before 39 weeks' gestation, OPM asked for related program information.

The guidance also notes that plans are required to cover contraceptive services at no cost sharing for plan year 2013, in line with regulations on preventive services from the Department of Health and Human Services.