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About Us / Our Mission, Role & History / Agency Equity Action Plan / Equity Action Plan of the Federal Employees Health Benefits Decision Support Tool

Equity Action Plan of the Federal Employees Health Benefits Decision Support Tool

 

OPM provides human resources leadership and support to Federal agencies and helps the Federal workforce achieve their aspirations as they serve the American people. OPM advances equitable contracting and procurement opportunities through the Federal Employees Health Benefits (FEHB) Program by incorporating anti-discrimination legal requirements in the contracts with the more than 90 national, regional, and community based insurance carriers. OPM also proactively promotes health equity by requiring carriers to assess differences in health outcomes by race and other social characteristics and address social determinants of health in their benefit design.

Barrier to Equitable Outcome(s)

The FEHB Program is the largest employer-sponsored health benefits program in the world, covering 8.2 million lives and providing a total of 275 plan choices (in 2022). OPM’s current FEHB Plan Comparison Tool (PCT) displays, in an accessible format, FEHB health plan choices for users, including premiums, out-of-pocket costs for a wide variety of benefits, and quality information to assist in their purchasing decisions. However, it does not currently support some of the unique needs of its users, including those in underserved communities. The PCT offered by OPM was developed in-house in 2002 and is the most frequently visited webpage for OPM/Healthcare and Insurance (top 5 on opm.gov). In 2020, there were 2.4 million page views, 1.6 million User Sessions, and 1.3 million unique views. It has been updated through several iterations to increase functionality, but it is at the end of its lifecycle and unable to deliver a versatile or comprehensive interface when compared to newer commercial models, such as tools developed for Healthcare.gov or other state-based exchanges.

There are several limitations for employees using the PCT to meet their FEHB plan choice needs. All current and prospective Federal employees are impacted by the available FEHB PCT technology; persons with specialized health care needs, such as people with disabilities, retirees, and the LGBTQ+ populations, are most impacted by the inability to conduct a specialized plan benefit search to find a health plan that best meets their needs. When selecting a plan, representatives of those in underserved communities, such as the LGBTQ+, retiree, and employees of tribal organizations, speak of the cumbersome and inequitable nature of utilizing the current PCT to compare or understand their health benefits. Additionally, FEHB enrollees within and outside of these communities often must compare benefits in each health plan brochure and check multiple health plan websites to contrast prescription drug costs as well as obtain participating healthcare provider information. Similarly, human resource specialists and agency benefits officers share the challenges and time demands of explaining health plan choices to enrollees.

Through OPM’s Equity Assessment focus groups, OPM was able to elicit certain stakeholder challenges in comparing FEHB benefits that impact many users. For instance, Federal employees mentioned that they find it very difficult to discern the information they need to select an FEHB plan and reported a lack of clarity around coverage by plans for necessary services, medications, or medical equipment. Federal employees, including those in underserved communities, request the ability to search for targeted information to help them make decisions during their FEHB plan selection. A new Decision Support Tool (DST) will give every FEHB-eligible individual the opportunity to improve health outcomes by enhancing decision support at the point of enrollment and offering the necessary, accessible technology to support user-centric comparison of FEHB benefits.

Action and Intended Impact on Barrier

OPM intends to provide customers a DST that is accessible by providing substantially equivalent access to persons with disabilities as provided to those without disabilities. This will permit users to compare available FEHB benefits, provider networks, and prescription costs. OPM will refactor the internal applications used to feed the DST to allow more granular collection of FEHB benefit information including total cost of care data. OPM will subsequently conduct various analyses, surveys, and focus groups to inform what technology enhancements are necessary. Lastly, OPM will iteratively release DST functionality to ensure continual alignment with Executive Order 13985.

By implementing the DST Minimum Viable Product (MVP), OPM will provide all users, including underserved communities, with the ability to compare the FEHB benefits, provider networks, and prescription costs important to them. Additionally, the refactoring of OPM systems used to gather DST source data will allow for more granular benefit data collection and subsequent specialized search and compare features to be implemented to the DST.

Tracking Progress

The DST MVP will be launched in year two after approval; starting in year three, the DST will deploy a web-based survey to collect a baseline data source on direct DST user experience to measure utilization, satisfaction and utility across different demographic groups and special populations to enable comparative analyses. OPM will also collect DST usage analytics to track DST reach and identify additional enhancements to DST functionality. The measures that OPM will capture include:

  • Percentage of DST users who report the DST is useful when selecting a health plan, by demographic group
  • Percentage of DST users who report that the categories available for comparison (e.g., quality ratings) are useful when selecting a health plan, by demographic group
  • Number of page views, sessions initiated, time spent using the DST, and other usage analytics
  • Percentage of DST users who report being satisfied with the DST, by demographic group
  • Percentage of employees who report having sufficient information to choose the right health plan for them, by demographic group
  • Number of searches by category, including by underserved communities’ need-specific terms (e.g., gender affirming care), by demographic group

Within five to eight years, the DST will be a steady state mobile-friendly, accessible tool with customized benefit search and compare capabilities, functionality to calculate total costs, and integrated provider and pharmacy directories. Additionally, the DST data source technology refactoring efforts will be completed and allow for more specialized benefit comparisons. The ultimate DST will give FEHB enrollees the option for tailored benefit differentiation through a secure portal and online support.

OPM will continue to track website survey and engagement measures to identify trends in use of the DST. Additionally, OPM will leverage the Federal Employee Benefits Survey (FEBS) and analyses of FEHB enrollment data to assess the following measures (organized by available aggregated, anonymized demographic data). These measures will supplement the information collected above via the DST direct user survey:

  • Percentage of employees who agree that the DST provides adequate FEHB plan benefit information, by demographic group
  • Percentage of employees who report being satisfied with the DST, by demographic group
  • Percentage of employees who report having sufficient information to choose the right health plan for them, by demographic group
  • Percentage enrolled in FEHB, by plan and user demographic

Accountability

OPM is including the DST efforts in the FY 2022-2026 Strategic Plan and as an FY 2022-2023 Agency Priority Goal. In addition, research questions related to the DST are encompassed in OPM’s FY 2022-2026 Learning Agenda.