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Healthcare Plan Information

 

Overview - Ensuring Quality Healthcare

What is quality healthcare?

Great question.

Quality healthcare is: Better Care and Better Health at Lower Cost.

All FEHB plans support quality with educated health professionals, efficient hospitals, nursing homes, clinics, accurate medical records, and open communication. OPM's definition and evaluation of quality care is strengthened by your health plan selection, feedback, and health improvement.

Why is quality healthcare important to me?

We can suggest a few reasons...

The plan you choose can make a difference in your health! A quality health plan will:

  • Improve healthcare outcomes by using evidence-based research and technology to promote the selection and delivery of the best possible care.
  • Reduce unnecessary health care costs.

How does OPM help me select quality healthcare?

We give you our best!

We work with health plans to advance healthcare delivery, concentrating on common health conditions to provide overall better patient health. Learn more about the quality evaluation system.

We offer health plans that build a positive healthcare experience, responding attentively to patient feedback regarding doctors and services. Learn more about member experiences and how they're reported.

And

We incentivize health plans to slow the growth of healthcare costs, so that all enrollees can afford quality care (and perhaps save more money to take that family vacation...)

I need additional resources to help make my decision.

We're here to help.

Below, you will find links to non-OPM websites that provide information on assuring quality in health care.

Consumer Satisfaction Survey

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. OPM then collects and analyzes these CAHPS® metrics. 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.

You can find information on customer satisfaction for many FEHB plans with our Plan Comparison Tool. Please go to www.opm.gov/fehbcompare to access customer satisfaction information, and other information that can help you in choosing a health plan.

Quality Scoring Results

Quality Healthcare for the Federal Population

The Office of Personnel Management (OPM) is proud to provide quality healthcare choices. To help you select a health plan that meets your needs and your family’s healthcare needs, we developed a quality evaluation system that allows you to gauge health plan performance for significant health issues, such as cancer, heart disease, diabetes, and mental health.

OPM evaluates health plan performance across nine major health issues in the FEHB population. View the health issues in the table of contents to view each health plans’ performance compared to United States National Health Maintenance Organization (HMO)Preferred Provider Organization (PPO)Point of Service Organization (POS), and All Lines of Business (LOB) Averages.

View a detailed explanation of OPM’s health plan evaluation system and scoring process.

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.

Healthcare Quality Scores and Status

You can find information on quality for many FEHB plans with our Plan Comparison Tool. Please go to www.opm.gov/fehbcompare to access quality information, and other information that can help you in choosing a health plan.

Quality Scoring Process

OPM’s Health Plan Evaluation and Scoring Process

For nine major health issues, OPM collects and analyses Healthcare Effectiveness Data and Information Set (HEDIS*) metrics. HEDIS metrics are a set of standardized performance measures that allow you to compare Federal Employees Health Benefits (FEHB) health plan performance industry benchmark percentiles of plan performance.

Each measure that’s being reported by FEHB plans is given a numeric percentage score. Each measure is scored and rated in comparison to the National Committee for Quality Assurance (NCQA) Quality Compass® (Quality Compass) Commercial benchmark for HEDIS and CAHPS measures. Specific benchmarks will reflect the plan-reported product type, and Health Maintenance Organization (HMO)Preferred Provider Organization (PPO), Point of Service Organization (POS), and All Lines of Business (LOB) are compared to applicable performance scores.

* HEDIS is sponsored, supported, and maintained by the National Committee for Quality Assurance (NCQA). More information on HEDIS and NCQA.

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