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Strategic Objective
SG09.02 Optimize insurance related business processes
Strategic Objective
Progress Update
During FY 2015, OPM developed an FEHB Health Plan Performance Assessment system to measure and reward FEHB plan performance through the use of common, objective, and quantifiable performance measures by the 2016 plan year. This is a new approach to assessing the annual performance of health plans contracted under the program. The performance assessment framework includes a discrete set of qualitative and quantifiable performance measures to assess key aspects of clinical quality, customer service, and resource use performance. Contracting officer’s oversight is also included in the categories of plan performance. The overall assessment is then linked to health plan profit factors. There are three primary quantitative categories of health plan performance in the assessment: improving health outcomes through quality care, providing effective customer service, and controlling cost growth.
The Bipartisan Budget Act of 2013 amended the FEHB statute to provide for a self plus one enrollment option in addition to the current self only and self and family enrollment options. During FY 2015, OPM worked with agencies, shared service centers, and Federal retirement programs to amend IT systems to accommodate the new enrollment option. OPM also worked closely with FEHB carriers to amend their IT systems and to submit rate proposals for the 2016 plan year that reflected the expected resource use of the self plus one enrolled population. The 2015 Open Season is the first opportunity for employees and retirees to enroll in self plus one.
OPM is also increasing IT security efforts and oversight for FEHB plans. OPM issued guidance to carriers on reporting security breaches and will continue to work with agency stakeholders on ensuring contractors follow IT security requirements.
One of OPM’s challenges is to ensure covered enrollees and family members have access to affordable health care. The inclusion of ineligible family members under self and family enrollments can adversely impact premium cost. The extent of ineligible family members covered under FEHB self and family enrollments are currently unknown. To address this gap, OPM procured the services of a contractor to perform an audit on a representative sample of family members on enrollees FEHB coverage to determine ineligible family members. The vendor is currently conducting an assessment, and OPM expects to review the results of the assessment in FY 2016.
