Human Resources and Security Specialists should use this tool to determine the correct investigation level for any covered position within the U.S. Federal Government.
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.
The plan you choose can make a difference in your health! A quality health plan will:
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.
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...)
Below, you will find links to non-OPM websites that provide information on assuring quality in health care.
Each year Federal Employees Health Benefits (FEHB) plans survey a sample of plan members to evaluate their health plan experiences.
OPM reports each health plan's scores on the survey questions listed below. We show the percentage of satisfied members on a scale of 0 to 100 and the national average for each question. This will let you compare plans to other plans, and the national average.
Since we offer a variety of plan types (HMO plans, FFS/PPO plans, HDHP plans, and CDHP plans), we calculate a separate national average for each plan type.
You can find survey results for the following key areas of member satisfaction in the Guide to Federal Benefits:
Generally, new plans and those with fewer than 500 FEHB enrollees do not participate in the survey. Therefore, some of the plans listed in the Guide will not have survey data.
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.
The Status list has been updated.
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 to the National Average health plan performance.
For each major health issue, 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.
Top performing health plans earn the highest recognition of 'Exemplary' status, and are marked with this symbol . Health plans that demonstrate significant progress earn 'Most Improved' status, and are marked with this symbol .
* HEDIS is sponsored, supported, and maintained by the National Committee for Quality Assurance (NCQA). More information on HEDIS and NCQA.