FEHBlog

FEHB Plans must begin to report on HEDIS standards in 2007

David Ermer–Uncategorized–
OPM issued a carrier letter today on its new 2007 requirement (described in the call letter) that fee-for-service plans report on certain HEDIS measures. The HEDIS measures concern the extent to which network health providers follow certain procedures. OPM will require the plans to collect data on breast cancer screening, cholesterol management for patients with cardiovascular conditions, and comprehensive diabetes care.

The OPM letter advises that “FEHB carriers will need to follow NCQA’s procedures for HEDIS reporting,including the HEDIS Compliance Audit which can be found on their website. The precise ncqa.com link for the HEDIS program is here and the link for the audit program is here .

In its April 7 press release, NCQA touts this development:“As the nation’s largest employer, the federal government has made a very powerful statement that every American needs good, comparable information about health care quality, regardless of the type of health plan they choose,” said NCQA President Margaret E. O’Kane. “When fee-for-service plans start reporting HEDIS data, for the first time federal workers will be able to determine which plans offer them the greatest value, and help keep their families the healthiest.”

HIT Developments

David Ermer–Uncategorized–

Dr. David Brailer, who has served as the Nation’s first health information technology czar (technically HHS National Coordinator for Health Information Technology under Executive Order 13335) has resigned after about two years in the position. According to the HHS Press Release, Dr. Brailer now will serve as Vice-Chair of the American Health Information Community , a HHS commission tasked with aiding in the creation of an interoperable health care technology system. Interestingly, Dr. Brailer recently stated that “You can’t impose government solutions on a technically evolving and complex system” like IT, said Brailer, who was participating in a health IT panel. “You can’t legislate good will, more efficient practices or better outcomes” (AHA News, 4/18).

Happy New Year!

David Ermer–Uncategorized–

The FEHB contracting year always kicks off with the U.S. Office of Personnel Management call letter which was released this year on April 4. The call letter seeks benefit and rate proposals from FEHB plan carriers. The carriers must submit the proposals by the end of May. Ensuing contract negotiations are concluded by mid-August, and then the carriers prepare for the annual Open Season from mid-November to mid-December.

Massachusetts Health Care Reform and the FEHBP

David Ermer–Uncategorized–

Many of the press reports that I have read about the newly enacted Massachusetts health care reform plan have focused on the individual mandate to purchase health insurance. A Heritage Foundation report, Edmund F. Haislmaier points out that the key component of the reform plan is a “Connector” which will allow consumers a choice of health insurance plans. Small businesses (50 employees or less) would be able to designate the Connector as its group insurance plan. This is very similar to the structure of the Federal Employees Health Benefits Program. In the FEHBP, OPM contracts with health plan carriers that offer their benefit arrangements to federal employees and annuitants. In another Heritage Foundation report, Prof. Regina Herzlinger favorably contrasts the Massachusetts reform with Maryland’s Walmart play or pay mandate.