It's a managed-care provider's dream population: 6,500 men and women whose average age is 30, each of whom has passed medical and dental examinations.
Here's the rub: They work in 63 different countries, including many remote locations where desolate conditions can take a toll on the mind and body.
They are Peace Corps volunteers.
When adequate care can't be provided on location, the Peace Corps airlifts volunteers to Washington, Hawaii or some intermediate site abroad for specialized medical services. Providers are reimbursed on a fee-for-service basis.
Like many governmental agencies, the Peace Corps thinks there's a more efficient way to manage that care. A May 26 request for proposals outlines its first, albeit limited, managed-care effort.
The request came from a task force that developed a plan for improving the corps' medical evacuations service, known as "medevac." The managed-care initiative targets 400 volunteers who are transported out of the field for specialized healthcare services each year. Proposals are due July 27.
"We're looking for a private-sector partner, an industry leader who really shares our dedication to high-caliber healthcare and has the ability to enhance our administrative and management capability," said Candy Hanson, Peace Corps' project manager.
Twenty-one individuals representing 16 managed-care providers, pharmaceutical companies and consulting firms attended a pre-proposal conference June 6 at Peace Corps headquarters in Washington. The registration list included representatives from SmithKline Beecham, Blue Cross and Blue Shield of the National Capital Area, Capital Physicians Network, MetraHealth and Foundation Health. It's unclear how many takers the corps will get.
Kevin Bacon, a senior vice president in the Fredericksburg, Va., office of Integrated Healthcare Services, a Sea Girt, N.J.-based consulting firm, attended on behalf of Humana, a Louisville, Ky.-based HMO. After the conference, Humana decided it wouldn't respond to the Peace Corps' request for proposals because the portion of the program targeted for managed care is too small, he said.
Hanson declined to give an estimate of the value of the proposed managed-care contract. Bacon said he didn't have such figures. But given the proj-ect's limited scope, he said, it would be very hard to make a profit.
According to the request for proposals, active volunteers consume the biggest portion of the corps' total healthcare expenditures. In fiscal 1994, they generated 2,695 claims totaling $1.8 million. The request didn't show what portion of the total claims expense represented medevac patients.
By comparison, the corps paid 5,673 claims worth $852,437 for health evaluations obtained by Peace Corps applicants. In the same year, the corps spent $659,821 for claims submitted by volunteers who are entitled to another six months of healthcare benefits once they complete their tour of duty.
Washington is the site of care for three of every four active volunteers who need special medical attention. Local Peace Corps' medical advisers work in consultation with physicians in the field to manage the patient's evaluation, treatment and follow-up care.
About three-quarters of medevac patients require outpatient services. Based on 1992 and 1993 claims data, 15% of the patients require mental health services-the largest single category of care. Many volunteers have assignments in very isolated parts of the world, Hanson said. "That presents adjustment issues for a lot of people," she explained.
Injuries and poisonings account for 9% of medevac cases.
While in Washington, volunteers receiving outpatient treatment are likely to be housed at the Virginian Hotel in Arlington, Va., under an agreement with the Peace Corps. So transportation to and from medical appointments is also an issue that needs to be considered in managing the corps' provider network.
Another complicating factor is the need for officials in Washington to make a decision about a volunteer's ability to return to the field within 45 days. That's about the longest the Peace Corps can afford to have a volunteer away from job responsibilities in the field, Hanson said.
Converting the Peace Corps' unwieldy paper-based claims system into a usable electronic information system is another priority of the managed-care project. Automating the system would enable the corps to save human labor and better assess volunteers' healthcare needs and experience. Any savings could be plowed into preventive services, Hanson said.
While the Peace Corps initiative may be tiny compared with other government-sponsored managed-care projects involving thousands of lives, it exemplifies a growing trend toward requests for proposals for managed care by national, state and local governments, Bacon said. That's good for consulting firms such as his that provide help to companies applying for contracts.
Bacon's firm, Integrated Healthcare Services, represents a growing list of clients that have hired it to respond to requests for proposals for managed-care initiatives by Medicaid, Medicare, the Pentagon and other government programs. "A lot of managed-care companies are looking to the federal government to expand their commercial base," Bacon said.
Obtaining a federal contract in a region gives the provider a platform on which to build its nongovernmental business, he explained.
Hanson acknowledged that the Peace Corps project represents a "unique situation." Nevertheless, the corps intends to move quickly and award a contract by the end of September at the latest, she said.