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Healthcare Ensuring Quality Healthcare

Results for coverage in 12020




Note about the Data Displayed Below

*OPM follows the National Committee for Quality Assurance (NCQA) measure reporting guidance. NCQA determined that some performance measure collection was impacted by COVID-19. As a result, some performance data displayed here reflects performance reported in 2019 rather than 2020. The reporting year is indicated within the measure title.




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 (2020) People with high blood pressure receive effective treatment. 2020 Reported
People with high blood pressure receive effective treatment. 2020 Reported
Comprehensive Diabetes Care - HbA1c <8% (2020) Do people with diabetes have their condition under control? 2020 Reported
Do people with diabetes have their condition under control? 2020 Reported
Timeliness of Prenatal Care (2019) Pregnant women receive care in the first trimester. 2019 Reported
Pregnant women receive care in the first trimester. 2019 Reported
Avoidance of Antibiotic Treatment for Acute Bronchitis / Bronchiolitis - Ages 18-64 (2020) Appropriate use of antibiotics for acute bronchitis. 2020 Reported
Appropriate use of antibiotics for acute bronchitis. 2020 Reported
Asthma Medication Ratio (2020) Appropriate ratio of controller medications to total asthma medications.2020 Reported
Appropriate ratio of controller medications to total asthma medications.2020 Reported
Breast Cancer Screening (2020) Do women who need screening mammograms get them? 2020 Reported
Do women who need screening mammograms get them? 2020 Reported
Follow-Up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence - 30-day (2020) Follow-up appointment within 30 days of discharge. 2020 Reported
Follow-up appointment within 30 days of discharge. 2020 Reported
Follow-Up After Emergency Department Visit for Mental Illness - 30-day (2020) Follow-up appointment within 30 days of discharge. 2020 Reported
Follow-up appointment within 30 days of discharge. 2020 Reported
Well-Child Visits in First 15 Months of Life (2020) Recommended well-child visits completed. 2020 Reported
Recommended well-child visits completed. 2020 Reported
Use of Imaging Studies for Low Back Pain (2020) Appropriate treatment of lower back pain. 2020 Reported
Appropriate treatment of lower back pain. 2020 Reported
Emergency Department Utilization (2020) Observed to expected emergency department visits. 2020 Reported
Observed to expected emergency department visits. 2020 Reported
Key: Outstanding Excellent Good Fair Poor       NA

NA is displayed if a plan did not report or is unable to report a result in this coverage area.

CDPHP Universal Benefits, Inc., Standard (SG) Outstanding Outstanding Outstanding Excellent Poor Outstanding Outstanding Good Outstanding Good Good
GEHA Benefit Plan, High (31) Good Excellent Excellent Fair Excellent Poor Good Fair Fair Good Fair
GEHA Benefit Plan, Standard (31) Good Excellent Excellent Fair Excellent Poor Good Fair Fair Good Fair
GEHA Benefit Plan, HDHP (34) Good Excellent Excellent Fair Excellent Poor Good Fair Fair Good Fair
Blue Cross and Blue Shield Service Benefit Plan, Standard (10) Excellent Good Excellent Poor Outstanding Good Excellent Excellent Good Fair Good
Blue Cross and Blue Shield Service Benefit Plan, Basic (11) Excellent Good Excellent Poor Outstanding Good Excellent Excellent Good Fair Good
SAMBA, High (44) Good Excellent Fair Fair Outstanding Fair Data Not Available Data Not Available Outstanding Fair Good
SAMBA, Standard (44) Good Excellent Fair Fair Outstanding Fair Data Not Available Data Not Available Outstanding Fair Good
Rural Carrier Benefit Plan, High (38) Good Excellent Fair Fair Outstanding Poor Poor Fair Poor Fair Poor
Foreign Service Benefit Plan, High (40) Good Excellent Poor Good Outstanding Fair Excellent Excellent Poor Good Excellent
Panama Canal Area Benefit Plan, High (43) Poor Outstanding Data Not Available Data Not Available Data Not Available Poor Data Not Available Data Not Available Data Not Available Data Not Available Poor
Blue Cross and Blue Shield Service Benefit Plan, FEP Blue Focus (13) Excellent Good Data Not Available Poor Outstanding Good Excellent Excellent Good Fair Good
MHBP - Standard and Value, Standard (45) Fair Outstanding Fair Fair Good Poor Poor Fair Fair Good Poor
MHBP Consumer Option, HDHP (48) Fair Outstanding Fair Fair Good Poor Poor Fair Fair Good Poor
NALC, High (32) Excellent Good Fair Outstanding Excellent Poor Outstanding Outstanding Poor Good Poor
Compass Rose Health Plan, High (42) Good Excellent Fair Fair Outstanding Good Data Not Available Good Good Poor Poor
APWU Health Plan, CDHP (47) Good Good Fair Fair Poor Poor Poor Poor Poor Good Poor
Aetna HealthFund HDHP and Aetna Direct Plan, HDHP (22) Fair Good Data Not Available Good Poor Poor Poor Good Excellent Good Good
Aetna HealthFund HDHP and Aetna Direct Plan, CDHP (N6) Fair Good Data Not Available Good Poor Poor Poor Good Excellent Good Good
Aetna HealthFund CDHP and Aetna Value Plan, CDHP (EP) Fair Good Fair Good Poor Poor Poor Good Excellent Good Good
Aetna HealthFund CDHP and Aetna Value Plan, Value (EP) Fair Good Fair Good Poor Poor Poor Good Excellent Good Good
Health Insurance Plan (HIP/HMO), High (51) Fair Poor Poor Fair Poor Good Poor Fair Poor Excellent Fair
Health Insurance Plan (HIP/HMO), Standard (YL) Fair Poor Poor Fair Poor Good Poor Fair Poor Excellent Fair
APWU Health Plan, High (47) Fair Fair Poor Poor Poor Fair Poor Fair Fair Good Poor
GHI Health Plan , Standard (80) Fair Poor Poor Outstanding Poor Poor Good Fair Poor Fair Poor
NALC, CDHP (32) Poor Poor Poor Outstanding Poor Poor Data Not Available Data Not Available Poor Fair Poor
NALC, Value (KM) Poor Poor Poor Outstanding Poor Poor Data Not Available Data Not Available Poor Fair Poor

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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 (2019) Members report getting the care they need. 2019 Reported
Members report getting the care they need. 2019 Reported
Claims Processing (2019) How quickly do customers say the plan handles claims? 2019 Reported
How quickly do customers say the plan handles claims? 2019 Reported
Overall Plan Satisfaction (2019) How pleased are customers with the plan overall? 2019 Reported
How pleased are customers with the plan overall? 2019 Reported
Coordination of Care (2019) Members say that their doctors know about care from other providers. 2019 Reported
Members say that their doctors know about care from other providers. 2019 Reported
Key: Outstanding Excellent Good Fair Poor       NA

NA is displayed if a plan did not report or is unable to report a result in this coverage area.

CDPHP Universal Benefits, Inc., Standard (SG) Outstanding Data Not Available Outstanding Excellent
GEHA Benefit Plan, High (31) Excellent Good Outstanding Good
GEHA Benefit Plan, Standard (31) Good Poor Good Poor
GEHA Benefit Plan, HDHP (34) Poor Fair Excellent Poor
Blue Cross and Blue Shield Service Benefit Plan, Standard (10) Good Good Excellent Fair
Blue Cross and Blue Shield Service Benefit Plan, Basic (11) Excellent Excellent Outstanding Poor
SAMBA, High (44) Outstanding Outstanding Outstanding Outstanding
SAMBA, Standard (44) Fair Fair Outstanding Fair
Rural Carrier Benefit Plan, High (38) Good Excellent Outstanding Good
Foreign Service Benefit Plan, High (40) Poor Poor Excellent Poor
Panama Canal Area Benefit Plan, High (43) Outstanding Data Not Available Outstanding Excellent
Blue Cross and Blue Shield Service Benefit Plan, FEP Blue Focus (13) Data Not Available Data Not Available Data Not Available Data Not Available
MHBP - Standard and Value, Standard (45) Outstanding Good Outstanding Fair
MHBP Consumer Option, HDHP (48) Excellent Fair Good Excellent
NALC, High (32) Good Excellent Outstanding Fair
Compass Rose Health Plan, High (42) Good Good Outstanding Poor
APWU Health Plan, CDHP (47) Good Fair Excellent Poor
Aetna HealthFund HDHP and Aetna Direct Plan, HDHP (22) Data Not Available Data Not Available Data Not Available Data Not Available
Aetna HealthFund HDHP and Aetna Direct Plan, CDHP (N6) Data Not Available Data Not Available Data Not Available Data Not Available
Aetna HealthFund CDHP and Aetna Value Plan, CDHP (EP) Fair Data Not Available Excellent Excellent
Aetna HealthFund CDHP and Aetna Value Plan, Value (EP) Fair Data Not Available Excellent Excellent
Health Insurance Plan (HIP/HMO), High (51) Poor Data Not Available Fair Data Not Available
Health Insurance Plan (HIP/HMO), Standard (YL) Poor Data Not Available Fair Data Not Available
APWU Health Plan, High (47) Good Fair Excellent Outstanding
GHI Health Plan , Standard (80) Good Data Not Available Excellent Data Not Available
NALC, CDHP (32) Fair Data Not Available Poor Data Not Available
NALC, Value (KM) Fair Data Not Available Poor Data Not Available

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  • 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.
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