Federal Employees Health Benefit Program - Data Request ...



|Federal Employees Health Benefit Program - Data Request for Plan Medical Directors |

|Patient Management Practices |

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|FEHBP Plan Name: ___________________________ Plan Number: _______________ |

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|Medical Director’s Name: ______________________ Phone Number: ______________ |

|Purpose: The purpose of this data request is to obtain information about the types of patient management practices used in FEHBP plans, and their |

|effectiveness in reducing costs. This data is being collected as part of a U.S. Office of Personnel Management-sponsored study of the cost of Federal and |

|state mandates on the FEHBP program. |

|Instructions: Indicate those patient management practices used in your plan by checking the appropriate boxes below (double click on the box). Where |

|appropriate, indicate the year in which the practice became effective, and your judgement about its impacts on cost reduction. |

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|Please respond to this data request by emailing or faxing the completed form to your contract specialist at the U.S. Office of Personnel Management no |

|later than October 4, 2002. |

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|Patient Management Activity |Not Used|Used |Effective Date|Effectiveness in Cost |

| | | |(YYYY) |Reduction |

| | | | |None Low Med High |

| | | | |( ................
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