Click here to skip navigation
U.S. flag

An official website of the United States government

Healthcare Ensuring Quality Healthcare

Results for coverage in 12020

Healthcare Quality Results

To help you select a health plan that meets your needs and your family’s healthcare needs, we developed a quality evaluation system using Healthcare Effectiveness Data and Information Set (HEDIS®) metrics that allows you to gauge health plan performance for significant health issues, including:

  • Preventive Care
  • Chronic Disease Management
  • Medication Use
  • Behavioral Health
  • Utilization Management

HEDIS metrics are a set of standardized performance measures that allow you to compare Federal Employees Health Benefits (FEHB) health plan performance to industry benchmark percentiles of plan performance using the key below. Plans are displayed based on their average performance on the first three quality measures.

Healthcare Effectiveness Data and Information Set
Plan Name Controlling High Blood Pressure People with high blood pressure receive effective treatment.
People with high blood pressure receive effective treatment.
 Timeliness of Prenatal Care Pregnant women receive care in the first trimester.
Pregnant women receive care in the first trimester.
 Avoidance of Antibiotic Treatment for Acute Bronchitis / Bronchiolitis Appropriate use of antibiotics for acute bronchitis.
Appropriate use of antibiotics for acute bronchitis.
 Asthma Medication Ratio Appropriate ratio of controller medications to total asthma medications.
Appropriate ratio of controller medications to total asthma medications.
 Follow Up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence 30 day Follow up appointment within 30 days of discharge.
Follow up appointment within 30 days of discharge.
 Follow Up After Emergency Department Visit for Mental Illness 30 day Follow up appointment within 30 days of discharge.
Follow up appointment within 30 days of discharge.
 Use of Imaging Studies for Low Back Pain Appropriate treatment of lower back pain.
Appropriate treatment of lower back pain.
 Glycemic Status Assessment for Patients With Diabetes: Glycemic Status <8.0% Do people with diabetes have their condition under control?
Do people with diabetes have their condition under control?
 Colorectal Cancer Screening: 51-75 Years Appropriate colorectal cancer screening received.
Appropriate colorectal cancer screening received.
Key: Outstanding Excellent Good Fair Poor NA

Note: NA is displayed if a plan did not report or is unable to report a result in this coverage area.
Foreign Service Benefit Plan, High Option (40) Excellent Fair Outstanding Excellent Outstanding Excellent Excellent Excellent Good
Panama Canal Area Benefit Plan, FFS Plan with a POS Option (43) Poor Data Not Available Outstanding Data Not Available Data Not Available Data Not Available Outstanding Outstanding Poor
MHBP, Value Option (41) Excellent Excellent Fair Good Outstanding Fair Fair Outstanding Good
MHBP, Standard Option (45) Excellent Excellent Fair Good Outstanding Fair Fair Outstanding Good
MHBP, Consumer Option (48) Excellent Excellent Fair Good Outstanding Fair Fair Outstanding Good
GEHA Indemnity Benefit Plan, Elevate Plus Option (25) Fair Fair Good Outstanding Poor Fair Excellent Poor Poor
GEHA Indemnity Benefit Plan, Elevate Option (25) Fair Fair Good Outstanding Poor Fair Excellent Poor Poor
Blue Cross and Blue Shield, Standard Option (10) Excellent Good Poor Excellent Good Good Fair Fair Excellent
Blue Cross and Blue Shield, Basic Option (11) Excellent Good Poor Excellent Good Good Fair Fair Excellent
Blue Cross and Blue Shield, FEP Blue Focus (13) Excellent Good Poor Excellent Good Good Fair Fair Excellent
Aetna: HDHP/Aetna Direct/Aetna Advantage, Aetna HealthFund HDHP (22) Poor Poor Good Fair Fair Fair Good Fair Good
Aetna HealthFund CDHP and Aetna Value Plan, Aetna HealthFund CDHP (EP) Poor Poor Good Fair Fair Fair Good Fair Good
Aetna HealthFund CDHP and Aetna Value Plan, Aetna Value Plan (EP) Poor Poor Good Fair Fair Fair Good Fair Good
Aetna: HDHP/Aetna Direct/Aetna Advantage, Aetna Direct (N6) Poor Poor Good Fair Fair Fair Good Fair Good
Aetna: HDHP/Aetna Direct/Aetna Advantage, Aetna Advantage (Z2) Poor Poor Good Fair Fair Fair Good Fair Good
APWU Health Plan, Consumer Driven Option (47) Fair Fair Fair Poor Poor Poor Good Fair Fair
GEHA, High Option (31) Fair Good Fair Good Poor Fair Good Fair Excellent
GEHA, Standard Option (31) Fair Good Fair Good Poor Fair Good Fair Excellent
GEHA, HDHP (34) Fair Good Fair Good Poor Fair Good Fair Excellent
Compass Rose Health Plan, High Option (42) Good Fair Fair Outstanding Data Not Available Data Not Available Poor Fair Excellent
Compass Rose Health Plan, Standard Option (42) Good Fair Fair Outstanding Data Not Available Data Not Available Poor Fair Excellent
SAMBA, High (44) Fair Fair Fair Excellent Data Not Available Data Not Available Poor Poor Good
SAMBA, Standard (44) Fair Fair Fair Excellent Data Not Available Data Not Available Poor Poor Good
APWU Health Plan, High Option (47) Poor Fair Poor Fair Poor Poor Fair Poor Good

Back to Top

Consumer Satisfaction Survey Results

Each year Federal Employees Health Benefits (FEHB) plans send the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey to a sample of plan members to evaluate their health plan experiences in key areas, including:

  • Communication
  • Access
  • Claims
  • Member Experience/Engagement

CAHPS® metrics are a set of standardized performance measures that allow you to compare Federal Employees Health Benefits (FEHB) health plan performance to industry benchmark percentiles of plan performance using the key below. Plans are displayed based on their average performance on the first three quality measures.

Consumer Assessment of Healthcare Providers and Systems
Plan Name Getting Needed Care Members report getting the care they need.
Members report getting the care they need.
 Claims Processing How quickly do customers say the plan handles claims?
How quickly do customers say the plan handles claims?
 Overall Plan Satisfaction How pleased are customers with the plan overall?
How pleased are customers with the plan overall?
 Coordination of Care Members say that their doctors know about care from other providers.
Members say that their doctors know about care from other providers.
Key: Outstanding Excellent Good Fair Poor NA

Note: NA is displayed if a plan did not report or is unable to report a result in this coverage area.
Blue Cross and Blue Shield, Standard Option (10) Excellent Fair Excellent Fair
Blue Cross and Blue Shield, Basic Option (11) Good Good Good Poor
Blue Cross and Blue Shield, FEP Blue Focus (13) Good Data Not Available Fair Data Not Available
Aetna: HDHP/Aetna Direct/Aetna Advantage, Aetna HealthFund HDHP (22) Data Not Available Data Not Available Good Data Not Available
GEHA Indemnity Benefit Plan, Elevate Plus Option (25) Poor Data Not Available Fair Poor
GEHA Indemnity Benefit Plan, Elevate Option (25) Fair Poor Fair Excellent
GEHA, High Option (31) Good Fair Excellent Good
GEHA, Standard Option (31) Data Not Available Data Not Available Good Data Not Available
GEHA, HDHP (34) Fair Poor Fair Data Not Available
Foreign Service Benefit Plan, High Option (40) Poor Poor Outstanding Fair
MHBP, Value Option (41) Good Data Not Available Good Data Not Available
Compass Rose Health Plan, High Option (42) Fair Poor Excellent Poor
Compass Rose Health Plan, Standard Option (42) Fair Poor Excellent Poor
Panama Canal Area Benefit Plan, FFS Plan with a POS Option (43) Outstanding Fair Outstanding Good
SAMBA, High (44) Excellent Good Outstanding Good
SAMBA, Standard (44) Fair Fair Excellent Fair
MHBP, Standard Option (45) Excellent Good Outstanding Good
APWU Health Plan, High Option (47) Good Fair Excellent Outstanding
APWU Health Plan, Consumer Driven Option (47) Fair Data Not Available Excellent Data Not Available
MHBP, Consumer Option (48) Fair Data Not Available Excellent Data Not Available
Aetna HealthFund CDHP and Aetna Value Plan, Aetna HealthFund CDHP (EP) Data Not Available Data Not Available Good Data Not Available
Aetna HealthFund CDHP and Aetna Value Plan, Aetna Value Plan (EP) Data Not Available Data Not Available Good Data Not Available
Aetna: HDHP/Aetna Direct/Aetna Advantage, Aetna Direct (N6) Data Not Available Data Not Available Good Data Not Available
Aetna: HDHP/Aetna Direct/Aetna Advantage, Aetna Advantage (Z2) Data Not Available Data Not Available Good Data Not Available

Back to Top

  • 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.
  • The HEDIS® measures and specifications were developed by and are owned by the National Committee for Quality Assurance ("NCQA"). The HEDIS measures and specifications are not clinical guidelines and do not establish standards of medical care. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures or any data or rates calculated using the HEDIS measures and specifications and NCQA has no liability to anyone who relies on such measures or specifications. © 2012-2015 National Committee for Quality Assurance, all rights reserved.
  • The data contained herein is protected by copyright and other intellectual property laws or treatises. Reproduction or use of the data requires permission of NCQA and is subject to a license at the discretion of NCQA. Unauthorized copying or use if prohibited.
Control Panel