Pay & Benefits

The quality of federal health insurance increased in 2019

Federal health insurance carriers across plan type generally improved in the quality of care they offered to federal employees in 2019, according to the plan performance summary released by the Office of Personnel Management Feb. 18.

The performance evaluations score health insurers across three different categories — clinical quality, customer service and resource use — known collectively as QCR scoring.

According to the report, both the average and minimum QCR scores rose in 2019, with health maintenance organization plans — those that offer care through physicians and hospitals in a specific geographic area — achieving the highest average score of 0.703. Plans with a preferred provider organization scored an average of 0.647 and HMO plans with a point of service product scored 0.657 on average.

QCR scoring for federal health plans operates by using weighted measures, which place greater importance on offerings that control high blood pressure, provide timely prenatal care and reduce the likelihood of hospital readmission. Providers can also get a bump to their scores, called an improvement increment, if they have a healthcare measure that was previously below the 50th percentile and improved at a rate that was faster than their commercial peers.

“Approximately one percent of the overall FEHB premium payable to the carriers is at-risk based on their respective performance,” the plan summary states.

For 2020, OPM plans to promote comprehensive diabetes care and the use of imaging for lower back pain to the list of high priorities that receive a higher weight in evaluations.

For feds, the individual scores of each provider are likely to prove more helpful, as different plans may excel in areas that appeal to different employees. An employee that plans to start a family in the near future, for example, might more highly value outstanding prenatal care than an older employee, who may be more concerned about cancer screening.

The individual scores are shown in OPM’s plan comparison tool and compare quality webpages.

“We want federal employees to have the necessary information about a carrier when they are selecting a health plan that is right for their family,” said OPM Director Dale Cabaniss in a statement.

“The PPA provides those detailed metrics for the customer and keeps FEHB carriers accountable. We are pleased to make the results available to all FEHB subscribers to help them make choices that meet their health needs.”

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