OPM and FEHB plans and enrollees participate in a broad-based survey effort with other public and private employers by using the Consumer Assessment of Health Plans Survey. This survey is a widely accepted tool for obtaining customer feedback on their experiences with their health plans. Before you join a plan, it may help to know what people who use the plan say about it. The survey results are not provided or influenced by the health plans; they are solely based on the responses of enrolled individuals like yourself. The complete questionnaire (59 questions) is on our web site but for ease of presentation we have summarized findings in the following key areas:
What the survey asked health plan enrollees:
- Getting Needed Care. Did you have problems getting a referral to a specialist? Did you experience delays in obtaining care? Did you have problems getting the care you and your doctor believed necessary?
- Getting Care Quickly. When you called during regular office hours, did you get the advice or help you needed? Could you get an appointment for regular or routine health care as soon as you wanted?
- How Well Doctors Communicate. Did the doctors or other health providers listen carefully to you? Did they explain things in a way you could understand? Did they spend enough time with you?
- Customer Service. Were you helped when you called your plan's customer service department? Did you have problems with paperwork for your plan? Was it hard to find and understand information in the plan's written materials?
- Claims Processing. Did your plan handle your claims in a reasonable time? Did they handle your claims correctly?
- Overall Plan Satisfaction. How would you rate your overall experience with your health plan?
A plan may not be rated for one of three reasons:
- It is new to the FEHB program.
- The plan has fewer than 500 Federal subscribers, or
- The plan failed to administer the survey as we asked. We have identified the plans in this last category with an X.
Plans that enrollees rated significantly better than average in a category
have a 
,
average ratings get a 
,
and significantly below average get a 
.
Accreditation
Accreditation is the most widely accepted way to measure and evaluate health plan performance. It is a rigorous and comprehensive evaluation by independent organizations that assess the quality of the key systems and processes that managed care use. Accreditation may also include an assessment of the care and service plans are delivering in important areas of public concern such as immunization rates, mammography rates, and member satisfaction.
The National Committee for Quality Assurance (NCQA), the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), and the American Accreditation Healthcare Commission/URAC are independent, private, not-for-profit organizations dedicated to assessing and reporting on the quality of health care organizations. These organizations are completely independent of the health plans and issue their accreditation results without the approval of the health plans they review. We encourage all FEHB plans to get accreditation from a national accrediting organization.
Quality includes 1) the perception of the quality of care received and 2) the quality of medical care provided.
The first is measured by annual satisfaction surveys. The second is measured in part by accreditation. As an employer, accreditation to us means accountability to a customer and validation of selected measures of a health plan's operations. Enrollees can be assured that an independent organization has performed an unbiased assessment of a health plan's systems and found them to be of a particular quality. We think an accredited plan offers value to your health plan decision making.
Note: There are various reasons why a plan is not accredited; check with the plan for an explanation.