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Healthcare Plan Information

 

Overview - Ensuring Quality Healthcare

What is quality healthcare?

Great question.

Quality healthcare is: Better Care and Better Health at Lower Cost.

All FEHB plans support quality with educated health professionals, efficient hospitals, nursing homes, clinics, accurate medical records, and open communication. OPM's definition and evaluation of quality care is strengthened by your health plan selection, feedback, and health improvement.

Why is quality healthcare important to me?

We can suggest a few reasons...

The plan you choose can make a difference in your health! A quality health plan will:

  • Improve healthcare outcomes by using evidence-based research and technology to promote the selection and delivery of the best possible care.
  • Reduce unnecessary health care costs.

How does OPM help me select quality healthcare?

We give you our best!

We work with health plans to advance healthcare delivery, concentrating on common health conditions to provide overall better patient health. Learn more about the quality evaluation system.

We offer health plans that build a positive healthcare experience, responding attentively to patient feedback regarding doctors and services. Learn more about member experiences and how they're reported.

And

We incentivize health plans to slow the growth of healthcare costs, so that all enrollees can afford quality care (and perhaps save more money to take that family vacation...)

I need additional resources to help make my decision.

We're here to help.

Below, you will find links to non-OPM websites that provide information on assuring quality in health care.

About Member Survey

Each year Federal Employees Health Benefits (FEHB) plans survey a sample of plan members to evaluate their health plan experiences.

In the Guide to Federal Benefits, OPM reports each health plan's scores on the survey questions listed below. We show the percentage of satisfied members on a scale of 0 to 100 and the national average for each question. This will let you compare plans to other plans, and the national average.

Since we offer a variety of plan types (HMO plans, FFS/PPO plans, HDHP plans, and CDHP plans), we calculate a separate national average for each plan type.

You can find survey results for the following key areas of member satisfaction in the Guide to Federal Benefits:

  • Overall Plan Satisfaction - This measure is based on the question, "Using any number from 0 to 10, where 0 is the worst health plan possible and 10 is the best health plan possible, what number would you use to rate your health plan?" We report the percent of respondents who rated their plan 8 or higher.
  • Getting Needed Care - How often was it easy to get an appointment, the care tests, or treatment you thought you needed through your health plan?
  • Getting Care Quickly - When you needed care right away, how often did you get care as soon as you thought you needed? Not counting the times you needed care right away, how often did you get an appointment at a doctor's office or clinic as soon as you thought you needed?
  • How Well Doctors Communicate - How often did your personal doctor explain things in a way that was easy to understand? How often did your personal doctor listen carefully to you, show respect for what you had to say, and spend enough time with you?
  • Customer Service - How often did the written materials or the Internet provide information you needed about how your health plan works? How often did your health plan's customer service give you the information or help you needed?
  • Claims Processing - How often did your health plan handle your claims quickly and correctly?
  • Plan Information on Costs - How often were you able to find out from your health plan how much you would have to pay for a health care service or equipment, or for specific prescription drug medicines?

Generally, new plans and those with fewer than 500 FEHB enrollees do not participate in the survey. Therefore, some of the plans listed in the Guide will not have survey data.

Quality Scoring Results

Quality Healthcare for the Federal Population

The Office of Personnel Management (OPM) is proud to provide quality healthcare choices. To help you select a health plan that meets your needs and your family’s healthcare needs, we developed a quality evaluation system that allows you to gauge health plan performance for significant health issues, such as cancer, heart disease, diabetes, and mental health.

OPM evaluates health plan performance across 5 major health issues in the FEHB population. View the health issues in the table of contents to view each health plans’ performance compared to United States National Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO) Averages.

View a detailed explanation of OPM’s health plan evaluation system and scoring process.

The Status list has been updated.

Healthcare Quality Scores and Status Key: Exemplary Most Improved Above National Average Below National Average National Average
Status
Plan Name
Column Sort Up Arrow
Breast Cancer Screening
Diabetes Testing
Diabetes Screening
Cholesterol Testing
Mental Health
Aetna HealthFund 66%Below National Average 87%Equal To National Average 84%Above National Average 85%Above National Average 54%Above National Average
Aetna Open Access - Arizona 64%Below National Average 88%Below National Average 85%Equal To National Average 88%Equal To National Average 48%Below National Average
Aetna Open Access - California 68%Below National Average 85%Below National Average 84%Below National Average 89%Above National Average 55%Below National Average
Aetna Open Access - Delaware, Jersey, Pennsylvania 68%Below National Average 83%Below National Average 83%Below National Average 84%Below National Average 55%Below National Average
Aetna Open Access - Distric of Columbia 67%Below National Average 87%Below National Average 83%Below National Average 81%Below National Average 48%Below National Average
Aetna Open Access - Georgia 66%Below National Average 86%Below National Average 84%Below National Average 87%Below National Average 50%Below National Average
Aetna Open Access - New Jersey 65%Below National Average 88%Below National Average 86%Above National Average 88%Above National Average 63%Above National Average
Aetna Open Access - New York 65%Below National Average 84%Below National Average 84%Below National Average 87%Below National Average 51%Below National Average
Aetna Open Access - Pennsylvania 63%Below National Average 84%Below National Average 87%Above National Average 89%Above National Average 59%Above National Average
Aetna Open Access - Tennessee 62%Below National Average 86%Below National Average 82%Below National Average 88%Equal To National Average 40%Below National Average
Altius Health Plans 65%Below National Average 89%Below National Average 76%Below National Average 84%Below National Average 56%Below National Average
APWU Health Plan 61%Below National Average 74%Below National Average 69%Below National Average 67%Below National Average 40%Below National Average
Exemplary AultCare HMO 71%Below National Average 93%Above National Average 89%Above National Average 91%Above National Average 0%Below National Average
AvMed Health Plans 72%Equal To National Average 87%Below National Average 87%Above National Average 89%Equal To National Average 32%Below National Average
Blue Cross and Blue Shield Service Benefit Plan 69%Above National Average 86%Below National Average 81%Below National Average 84%Equal To National Average 49%Below National Average
Blue Preferred Plus POS 65%Below National Average 91%Equal To National Average 85%Below National Average 84%Below National Average 45%Below National Average
Blue Shield of CA Access+HMO 70%Below National Average 86%Below National Average 83%Below National Average 88%Below National Average 65%Above National Average
Exemplary Bluecare Network of MI 75%Above National Average 91%Equal To National Average 88%Above National Average 92%Above National Average 54%Below National Average
Exemplary Capital Health Plan 84%Above National Average 95%Above National Average 94%Above National Average 92%Above National Average 81%Above National Average
CareFirst BlueChoice 67%Below National Average 86%Below National Average 84%Below National Average 84%Below National Average 58%Below National Average
Exemplary and Most Improved CDPHP Universal Benefits, Inc. 72%Above National Average 90%Above National Average 88%Above National Average 95%Above National Average 74%Above National Average
Coventry Health Care - Iowa 63%Below National Average 94%Above National Average 89%Above National Average 89%Equal To National Average 45%Below National Average
Coventry Health Care - Kansas 66%Below National Average 86%Below National Average 80%Below National Average 85%Below National Average 54%Below National Average
Coventry Health Care - Louisiana 73%Above National Average 88%Below National Average 85%Below National Average 87%Below National Average 43%Below National Average
Coventry Health Care - Maryland 67%Below National Average 86%Below National Average 80%Below National Average 81%Below National Average 53%Below National Average
Exemplary and Most Improved Coventry Health Plan - Florida 77%Above National Average 89%Below National Average 87%Above National Average 92%Above National Average 0%Below National Average
Exemplary Dean Health Plan 71%Below National Average 95%Above National Average 90%Above National Average 91%Above National Average 71%Above National Average
Exemplary and Most Improved Fallon Community Health Plan 81%Above National Average 93%Above National Average 91%Above National Average 93%Above National Average 74%Above National Average
Foreign Service Benefit Plan 63%Below National Average 83%Below National Average 77%Below National Average 78%Below National Average 39%Below National Average
Most Improved GEHA Benefit Plan 62%Below National Average 88%Above National Average 83%Above National Average 82%Below National Average 41%Below National Average
Exemplary Geisinger Health Plan 75%Above National Average 94%Above National Average 91%Above National Average 91%Above National Average 72%Above National Average
GHI Health Plan 63%Below National Average 87%Equal To National Average 86%Above National Average 90%Above National Average 54%Above National Average
Globalhealth, Inc. 63%Below National Average 85%Below National Average 76%Below National Average 83%Below National Average 43%Below National Average
Exemplary Grand Valley Health Plan 83%Above National Average 98%Above National Average 96%Above National Average 99%Above National Average 0%Below National Average
Group Health Cooperative - Idaho and Washington 71%Below National Average 92%Above National Average 86%Equal To National Average 87%Below National Average 69%Above National Average
Exemplary Group Health Cooperative - Wisconsin 76%Above National Average 91%Equal To National Average 84%Below National Average 91%Above National Average 81%Above National Average
Health Alliance HMO 76%Above National Average 91%Equal To National Average 85%Below National Average 89%Equal To National Average 49%Below National Average
Health Alliance Plan 77%Above National Average 89%Below National Average 83%Below National Average 86%Below National Average 68%Above National Average
Health Net of Arizona, Inc. 62%Below National Average 91%Equal To National Average 87%Above National Average 89%Equal To National Average 62%Above National Average
Health Net of California 69%Below National Average 88%Below National Average 85%Below National Average 90%Above National Average 54%Below National Average
Health Plan of Nevada 62%Below National Average 89%Below National Average 87%Above National Average 87%Below National Average 71%Above National Average
Exemplary HealthAmerica Pennsylvania 74%Above National Average 96%Above National Average 93%Above National Average 96%Above National Average 77%Above National Average
Exemplary HealthPartners High and Standard Option 75%Above National Average 97%Above National Average 92%Above National Average 91%Above National Average 67%Above National Average
Exemplary HealthPlus of MI 82%Above National Average 92%Above National Average 91%Above National Average 93%Above National Average 67%Above National Average
Exemplary HealthSpan Integrated Care 75%Above National Average 96%Above National Average 96%Above National Average 97%Above National Average 72%Above National Average
Exemplary HIP Health of Greater New York 74%Above National Average 90%Below National Average 90%Above National Average 90%Above National Average 69%Above National Average
Exemplary HMSA 78%Above National Average 91%Equal To National Average 91%Above National Average 93%Above National Average 65%Above National Average
Humana Employers Health of Georgia, Inc. 65%Below National Average 87%Below National Average 82%Below National Average 89%Above National Average 41%Below National Average
Humana Health Plan of Texas - Austin 61%Below National Average 89%Below National Average 84%Below National Average 88%Equal To National Average 29%Below National Average
Humana Health Plan of Texas - San Antonia 65%Below National Average 88%Below National Average 82%Below National Average 91%Above National Average 33%Below National Average
Humana Health Plan, Inc. - Chicago Market 69%Below National Average 84%Below National Average 83%Below National Average 89%Above National Average 46%Below National Average
Humana Health Plan, Inc. - Kansas City 70%Equal To National Average 88%Below National Average 84%Below National Average 89%Above National Average 30%Below National Average
Humana Health Plans of Puerto Rico, Inc. 45%Below National Average 80%Below National Average 82%Below National Average 84%Below National Average 0%Below National Average
Humana Medical Plan, Inc. - Florida 71%Above National Average 89%Below National Average 88%Above National Average 92%Above National Average 35%Below National Average
Exemplary Independent Health Assoc 74%Above National Average 92%Above National Average 91%Above National Average 92%Above National Average 71%Above National Average
Exemplary Kaiser Foundation Health Plan Mid-Atlantic States 85%Above National Average 96%Above National Average 96%Above National Average 96%Above National Average 61%Above National Average
Exemplary Kaiser Foundation Health Plan of Colorado 76%Above National Average 94%Above National Average 87%Above National Average 93%Above National Average 89%Above National Average
Exemplary Kaiser Foundation Health Plan of Georgia 78%Above National Average 92%Above National Average 91%Above National Average 97%Above National Average 64%Above National Average
Exemplary Kaiser Foundation Health Plan of Hawaii 82%Above National Average 95%Above National Average 93%Above National Average 98%Above National Average 76%Above National Average
Exemplary Kaiser Foundation Health Plan of Northern California 84%Above National Average 96%Above National Average 93%Above National Average 96%Above National Average 76%Above National Average
Exemplary Kaiser Foundation Health Plan of Northwest 80%Above National Average 94%Above National Average 92%Above National Average 95%Above National Average 80%Above National Average
Exemplary Kaiser Foundation Health Plan of Southern California 79%Above National Average 94%Above National Average 92%Above National Average 96%Above National Average 75%Above National Average
KPS Health Plans 62%Below National Average 87%Equal To National Average 77%Below National Average 77%Below National Average 44%Below National Average
Most Improved Lovelace Health Plan 66%Below National Average 86%Below National Average 80%Below National Average 83%Below National Average 75%Above National Average
M.D. IPA 68%Below National Average 89%Below National Average 85%Equal To National Average 87%Below National Average 61%Above National Average
MHBP - Std 59%Below National Average 82%Below National Average 77%Below National Average 80%Below National Average 51%Below National Average
MVP Health Care 70%Below National Average 90%Below National Average 84%Below National Average 88%Below National Average 71%Above National Average
Most Improved NALC 61%Below National Average 86%Below National Average 83%Above National Average 86%Above National Average 28%Below National Average
Optima Health Plan 70%Below National Average 90%Below National Average 85%Below National Average 89%Equal To National Average 75%Above National Average
Panama Canal Area Benefit Plan 56%Below National Average 94%Above National Average 72%Below National Average 62%Below National Average 3%Below National Average
Presbyterian Health Plan 65%Below National Average 85%Below National Average 75%Below National Average 86%Below National Average 40%Below National Average
Rural Carrier Benefit Plan 61%Below National Average 83%Below National Average 77%Below National Average 82%Below National Average 42%Below National Average
SAMBA 69%Above National Average 81%Below National Average 75%Below National Average 77%Below National Average 24%Below National Average
SelectHealth 65%Below National Average 93%Above National Average 83%Below National Average 91%Above National Average 51%Below National Average
TakeCare 56%Below National Average 59%Below National Average 59%Below National Average 76%Below National Average 38%Below National Average
The Health Plan of the Upper Ohio Valley 71%Below National Average 88%Below National Average 82%Below National Average 84%Below National Average 60%Equal To National Average
Triple-S Salud, Inc. 59%Below National Average 74%Below National Average 76%Below National Average 81%Below National Average 31%Below National Average
United Healthcare of the Midwest, Inc. 69%Below National Average 87%Below National Average 82%Below National Average 84%Below National Average 64%Above National Average
UnitedHealthcare Benefits of Texas, Inc. 62%Below National Average 93%Above National Average 89%Above National Average 88%Below National Average 60%Equal To National Average
UnitedHealthcare of California 70%Below National Average 92%Above National Average 87%Above National Average 91%Above National Average 71%Above National Average
UnitedHealthcare Plan of the River Valley Inc. 68%Below National Average 91%Above National Average 84%Below National Average 87%Below National Average 54%Below National Average
UPMC Health Plan 75%Above National Average 90%Below National Average 88%Above National Average 91%Above National Average 76%Above National Average

Healthcare Effectiveness Data and Information Set (HEDIS®), source of the data presented on this web page, is a registered trademark of the National Committee for Quality Assurance (NCQA). View more information on the collection and assessment of HEDIS.

Quality Scoring Process

OPM’s Health Plan Evaluation and Scoring Process

For five major health issues, OPM collects and analyses Healthcare Effectiveness Data and Information Set (HEDIS*) metrics. HEDIS metrics are a set of standardized performance measures that allow you to compare Federal Employees Health Benefits (FEHB) health plan performance to the National Average health plan performance.

For each major health issue, Preferred Provider Organizations (PPOs) and Health Maintenance Organizations (HMOs) are compared to applicable performance scores.

Top performing health plans earn the highest recognition of 'Exemplary' status, and are marked with this symbol Exemplary symbol. Health plans that demonstrate significant progress earn 'Most Improved' status, and are marked with this symbol Most Improved symbol.

* HEDIS is sponsored, supported, and maintained by the National Committee for Quality Assurance (NCQA). More information on HEDIS and NCQA.

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