The Office of Personnel Management (OPM) has been pushing for more transparency in Federal Employee Health Benefit Plans (FEHBP) for years. OPM required participating carriers to begin providing drug transparency tools in 2016 and has been working towards certain improvements since then. In 2019, they called on carriers to provide tools by 2021 that would “allow members to estimate accurately the dollar amount they should expect to pay for a defined set of common outpatient and elective in-patient health care procedures and services … based on the member’s plan option and deductible status.” And by 2022, all carriers are expected to publicly post the network contracting status of certain specialty physicians, physician groups, and urgent care services.
Know before you go
Some FEHBP carriers stand out in their efforts towards transparency. Kaiser Permanente, for example, isn’t just a health insurance provider. It’s an integrated health system that provides both health insurance and health care. Because of this synergy, information about pricing and quality becomes simpler and easier to access. This transparency is important for fostering the continued quality and affordability of FEHBP and aiding in personal health care decision-making.
Most providers charge coinsurance—a percentage of the total cost of the service. Without knowing the total cost in advance, Federal employees never know what the price tag will be until they get their bill. In health plans that primarily charge copays, like Kaiser Permanente, costs are predetermined for nearly every service. This makes costs more predictable and eliminates surprise bills—not to mention paperwork.
“So with those price certainties in place with Kaiser, you don’t have that surprise element,” said Gavin Toner, manager of the Federal Employee Benefit Plans at Kaiser Permanente. “I frankly welcome this push for transparency, because with Kaiser, generally speaking, when you shine light on us, it really reflects in a good way on how we do business, in the community and with our members.”
Quality of care
An integrated care system doesn’t just enhance transparency. When plan members get their health care and health insurance through the same system, everything is connected, improving ease and quality of care. At Kaiser Permanente, every doctor has shared access to members’ health information, which allows them to provide personalized care. This results in the right diagnoses and faster treatments. And since all Permanente physicians are connected, members don’t have to go looking for third-party specialists or negotiate referrals—the heavy lifting is done by their care team, within the integrated care system.
Where do we find information about quality of care? Carriers in the FEHB Program make various tools available on their websites to help interested individuals find cost and quality information about the providers in their networks. OPM follows the National Committee for Quality Assurance (NCQA) measure reporting guidance to assess quality of care. Kaiser Permanente and many other carriers may make this information available to members on their websites and other materials. NCQA recently released their current ratings, placing three of Kaiser Permanente’s plans among the top in the nation. Their commercial and Medicare plans for DC, MD, and VA are the top-rated plans available to Federal employees.
Tools to easily understand quality and costs
Beginning in 2016, OPM has asked all carriers to provide prescription cost estimator tools to help inform FEHB plan members. In 2021, this has been expanded to ensure Federal employees have easy access to quality and pricing information. Federal employees can compare plan quality and costs with OPM’s comparison tool.
To meet OPM’s request, Kaiser Permanente makes quality and pricing information available on their own website and in their enrollment materials. Most carriers, including Kaiser Permanente, publish a plan books that details all its benefits. Many health plans do the same, but they tend to get lost in the fine print. “Kaiser Permanente provides easy-to-understand companion pieces with snapshots of everyday services like primary care, emergency care, and mental health to make comparison easier,” Toner said.
“Around 90% of your costs are those predictable, everyday costs,” Toner said. “And so we make sure that the people know what those costs are upfront. And when you look at our charts, you’ll see that it’s all copay driven. So there’s nothing that’s going to catch you on the backside after a service.”
As a nonprofit, Kaiser Permanente isn’t motivated by financial incentives, further enhancing predictability. Permanente physicians are all salaried, not paid per service; there’s no incentive to raise or obscure prices. Instead, they’re focused on providing the best care possible while personally informing their patients of costs—and helping them stay on top of their health. All care decisions are made by members and their care teams, not an insurance company.
“Those annual things that you’re meant to get done, if you use Kaiser Permanente, we make sure that it’s done because everybody that works in the medical group can ensure that we’re constantly working to close any health gaps and make sure that your outcomes and your health in general is the best it can possibly be,” Toner said. “We have the same specialties at Kaiser Permanente, we have richer benefits, we have better health outcomes, and we have lower premiums.”
The price of a health plan has no correlation with quality of care received. That’s why OPM requires carriers to make information about their quality of care easily accessible, so federal employees can make better health care decisions for themselves and their families.
Amelia Brust/Federal News Network
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