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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 Timeliness of Prenatal Care Pregnant women receive care in the first trimester.
Pregnant women receive care in the first trimester.
Controlling High Blood Pressure People with high blood pressure receive effective treatment.
People with high blood pressure receive effective treatment.
Plan All Cause Readmissions Reduced likelihood of readmission following inpatient hospital stay.
Reduced likelihood of readmission following inpatient hospital stay.
Breast Cancer Screening Do women who need screening mammograms get them?
Do women who need screening mammograms get them?
Well-Child Visits in First 15 Months of Life Recommended well-child visits completed.
Recommended well-child visits completed.
Asthma Medication Ratio Appropriate ratio of controller medications to total asthma medications.
Appropriate ratio of controller medications to total asthma medications.
Avoidance of Antibiotics in Adults with Acute Bronchitis Appropriate use of antibiotics for acute bronchitis.
Appropriate use of antibiotics for acute bronchitis.
Comprehensive Diabetes Care - HbA1c <8% Do people with diabetes have their condition under control?
Do people with diabetes have their condition under control?
Follow-up after Hospital 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.
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., High (SG) Outstanding Outstanding Excellent Outstanding Outstanding Excellent Excellent Outstanding Outstanding Fair
CDPHP Universal Benefits, Inc., Standard (SG) Outstanding Outstanding Excellent Outstanding Outstanding Excellent Excellent Outstanding Outstanding Fair
Blue Cross and Blue Shield Service Benefit Plan, Standard (10) Excellent Excellent Good Excellent Good Excellent Fair Fair Fair Fair
Blue Cross and Blue Shield Service Benefit Plan, Basic (11) Excellent Excellent Good Excellent Good Excellent Fair Fair Fair Fair
Compass Rose Health Plan, High (42) Fair Fair Outstanding Good Good Outstanding Good Good Fair Fair
Panama Canal Area Benefit Plan, High (43) Data Not Available Poor Outstanding Poor Data Not Available Data Not Available Data Not Available Outstanding Data Not Available Data Not Available
GEHA Benefit Plan, High (31) Excellent Good Fair Poor Fair Good Fair Excellent Fair Good
GEHA Benefit Plan, Standard (31) Excellent Good Fair Poor Fair Good Fair Excellent Fair Good
GEHA Benefit Plan, HDHP (34) Excellent Good Fair Poor Fair Good Fair Excellent Fair Good
Rural Carrier Benefit Plan, High (38) Fair Good Good Poor Poor Excellent Poor Excellent Fair Fair
NALC, High (32) Fair Excellent Poor Poor Poor Excellent Poor Fair Good Fair
SAMBA, High (44) Fair Good Poor Good Fair Outstanding Fair Good Fair Good
SAMBA, Standard (44) Fair Good Poor Good Fair Outstanding Fair Good Fair Good
APWU Health Plan, High (47) Poor Fair Good Fair Poor Poor Outstanding Fair Poor Good
MHBP - Standard and Value, Value (41) Fair Fair Fair Poor Poor Good Fair Outstanding Poor Fair
MHBP - Standard and Value, Standard (45) Fair Fair Fair Poor Poor Good Fair Outstanding Poor Fair
MHBP Consumer Option, HDHP (48) Fair Fair Fair Poor Poor Good Fair Outstanding Poor Fair
Aetna HealthFund CDHP and Aetna Value Plan, CDHP (EP) Fair Poor Fair Fair Good Fair Good Good Fair Good
Aetna HealthFund CDHP and Aetna Value Plan, Value (EP) Fair Poor Fair Fair Good Fair Good Good Fair Good
Foreign Service Benefit Plan, High (40) Poor Good Poor Fair Poor Outstanding Excellent Excellent Outstanding Outstanding
APWU Health Plan, CDHP (47) Fair Fair Poor Poor Poor Poor Fair Fair Poor Good
Health Insurance Plan (HIP/HMO), High (51) Poor Poor Fair Fair Poor Fair Good Poor Poor Outstanding
Health Insurance Plan (HIP/HMO), Standard (YL) Poor Poor Fair Fair Poor Fair Good Poor Poor Outstanding
NALC, CDHP (32) Poor Poor Poor Poor Poor Poor Outstanding Poor Data Not Available Fair
NALC, Value (KM) Poor Poor Poor Poor Poor Poor Outstanding Poor Data Not Available Fair
Aetna HealthFund HDHP and Aetna Direct Plan, HDHP (22) NA NA NA NA NA NA NA NA NA NA
Aetna HealthFund HDHP and Aetna Direct Plan, CDHP (N6) NA NA NA NA NA NA NA NA NA NA

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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 Overall Plan Satisfaction How pleased are customers with the plan overall?
How pleased are customers with the plan overall?
Getting Needed Care Members report getting the care they need.
Members report getting the care they need.
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
Customer Service How satisfied are customers with the plan's customer service?
How satisfied are customers with the plan's customer service?
Claims Processing How quickly do customers say the plan handles claims?
How quickly do customers say the plan handles claims?
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., High (SG) Outstanding Outstanding Excellent Data Not Available Data Not Available
CDPHP Universal Benefits, Inc., Standard (SG) Outstanding Outstanding Excellent Data Not Available Data Not Available
Blue Cross and Blue Shield Service Benefit Plan, Standard (10) Excellent Good Fair Good Good
Blue Cross and Blue Shield Service Benefit Plan, Basic (11) Outstanding Excellent Poor Data Not Available Excellent
Compass Rose Health Plan, High (42) Outstanding Good Poor Good Good
Panama Canal Area Benefit Plan, High (43) Outstanding Outstanding Excellent Poor Data Not Available
GEHA Benefit Plan, High (31) Outstanding Excellent Good Excellent Good
GEHA Benefit Plan, Standard (31) Good Good Poor Poor Poor
GEHA Benefit Plan, HDHP (34) Excellent Poor Poor Fair Fair
Rural Carrier Benefit Plan, High (38) Outstanding Good Good Excellent Excellent
NALC, High (32) Outstanding Good Fair Fair Excellent
SAMBA, High (44) Outstanding Outstanding Outstanding Excellent Outstanding
SAMBA, Standard (44) Outstanding Fair Fair Good Fair
APWU Health Plan, High (47) Excellent Good Outstanding Poor Fair
MHBP - Standard and Value, Value (41) Excellent Good Fair Fair Good
MHBP - Standard and Value, Standard (45) Outstanding Outstanding Fair Excellent Good
MHBP Consumer Option, HDHP (48) Good Excellent Excellent Poor Fair
Aetna HealthFund CDHP and Aetna Value Plan, CDHP (EP) Excellent Fair Excellent Data Not Available Data Not Available
Aetna HealthFund CDHP and Aetna Value Plan, Value (EP) Excellent Fair Excellent Data Not Available Data Not Available
Foreign Service Benefit Plan, High (40) Excellent Poor Poor Poor Poor
APWU Health Plan, CDHP (47) Excellent Good Poor Data Not Available Fair
Health Insurance Plan (HIP/HMO), High (51) Fair Poor Data Not Available Data Not Available Data Not Available
Health Insurance Plan (HIP/HMO), Standard (YL) Fair Poor Data Not Available Data Not Available Data Not Available
NALC, CDHP (32) Poor Fair Data Not Available Data Not Available Data Not Available
NALC, Value (KM) Poor Fair Data Not Available Data Not Available Data Not Available
Aetna HealthFund HDHP and Aetna Direct Plan, HDHP (22) NA NA NA NA NA
Aetna HealthFund HDHP and Aetna Direct Plan, CDHP (N6) NA NA NA NA NA

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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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